Jejunal Bowel Loop Hematoma: An Ultrasound diagnosis

A 6 yrs old female child with h/o  blunt abdominal trauma 3 days back, episode of malena, &  having pain abdomen,  was referred for ultrasound evaluation  of abdomen .  At USG  a well defined hypoechoic  oval mass was seen along jejunal  bowel loop,  likely involving its wall, with slight exophytic bulge , & focally distorting gut signature [ fig 1 & 2] . The mass  did not reveal internal vascularity on Doppler.  The affected segment of jejunum  was sluggishly motile , &  showed mild luminal narrowing  with  proximal fullness.  Surprisingly no any other evidence of intraabdominal free fluid , mesenteric mass or fluid ,or solid visceral injury  was detected on ultrasound .  In light of  h/o abdominal injury  ,  a diagnosis of  jejunal loop hematoma was suggested  , which was confirmed at surgery  ;  isolated jejunal  hematoma [ see fig- 3]. Case submitted by Dr. Subhash Tailor, MD, Bhilwara [ Rajasthan , India]

Fig 1 -   Left paraumbilical  transverse USG  image shows a well defined hypoechoic mass along jejunal  bowel loop making  exophytic bulge .

Fig 2 -  Obliquely longitudinal USG  scan shows the same mass along jejunal loop compressing the lumina. The mass was vascular on color Doppler.

Fig 3 – Per operative photograph revealing isolated segmental jejunal  wall hematoma.

[ Operative  photograph courtesy ; Dr. Gaurav Bahety M.Ch., Bhilwara ]