title: Gastrointestinal intramural hematoma--analysis of clinical and radiological features for early differentiation from mesenteric ischemia.
abstract: BACKGROUND
  Long-term anticoagulation is associated with hemorrhage at various sites. Gastrointestinal intramural bleeds and hematomas (IMH) often mimic mesenteric ischemia (MI) due to similar clinical settings and imaging features, making early differentiation difficult.
  
  
  OBJECTIVE
  To compare the demography, clinical features and imaging characteristics of patients presenting with IMH with those of MI, so as to help in evolving clinical and imaging guidelines to differentiate both early in the course of the disease.
  
  
  METHODS
  All radiologically (contrast-enhanced computed tomogram [CT]) diagnosed cases of gastrointestinal IMH from the hospital database during the period between 2006 and 2012 were retrospectively analyzed. This data was compared with the clinical and imaging features of a group of surgically confirmed MI during the same period. Patients not on anticoagulation therapy at the time of presentation and those with incomplete clinical or radiological data were excluded from the study.
  
  
  RESULTS
  There were 16 patients in IMH group and 54 patients in MI group. Clinical features like overt rectal bleeding or melena, and prolonged prothrombin time-international normalized ratio (PT-INR) more than three, and CT features like proximal location in the bowel, increased bowel wall thickness, hyperdensity on plain scan (>40 Hounsfield units (HU)), and short segment bowel involvement were significantly associated with IMH. Visualization of embolus and absent mesenteric vasculature to a segment of intestine in CT was significantly associated with MI.
  
  
  CONCLUSIONS
  Attention to clinical features and early CT scan can aid in early differentiation of IMH from MI, facilitating appropriate intervention early in the course of disease.
authors.affiliation: Department of Gastrointestinal Surgery and Liver Transplantation, Amrita Institute of Medical Sciences and Research Centre, Aims Ponekkara PO, Kochi, 682 041, India, drsubhashr@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Subhash
authors.forename: G
authors.initials: G
authors.lastname: Unnikrishnan
authors.forename: Dinesh
authors.initials: D
authors.lastname: Balakrishnan
authors.forename: O V
authors.initials: OV
authors.lastname: Sudheer
authors.forename: Puneet
authors.initials: P
authors.lastname: Dhar
authors.forename: S
authors.initials: S
authors.lastname: Sudhindran
mesh_terms: D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed