Benjamin M. Horwitz, MD ,G. Elizabeth Zamora, MD , Marcela P. Gallegos, MD
History
A 61 -year-old woman with no previous relevant medical conditions presented to the emergency department with a history of 10 days of melena and three episodes of fainting. The patient appeared pale. No palpable abdominal mass, abdominal pain, or other signs or symptoms were found at physical examination. A complete blood cell count showed a hematocrit level of 31%, with microcytic and hypochromic red blood cells. Her mean corpuscular volume was 75 fL (normal range, 80-98 fL), and her mean corpuscular hemoglobin was 24.6 pg (normal range, 26-34 pg) per cell. Her iron profile showed a low level of serum iron (28 µg/dL; normal range, 31-144 µg/dL) and diminished transferrin saturation (7.9%; normal range, 15%-50%). She underwent an upper gastrointestinal tract endoscopic examination with no abnormal findings.
Imaging Findings
Contrast material-enhanced abdominopelvic computed tomography (CT) was performed with both oral and intravenous contrast agents: 1 L diatrizoate meglumine and diatrizoate sodium was administered orally, and 120 mL io-hexol containing 300 mg iodine per milliliter was administered by intravenous injection at a rate of 3 mL/sec. There was a delay of 70 seconds between the injection and the initiation of scanning. The scanning parameters were 120 kVp, 180 mAs, pitch of 1, and section thickness of 3 mm. CT images revealed an exophytic mass arising from a small bowel (jejunal-proximal ileal) loop in the left lower quadrant. The dimensions (length x width x depth) of the mass were 5.6 x 6.0 x 5.8 cm. The mass contained prominent drainage veins and showed marked enhancement. It had a central cavity that was filled with gas; there was no sign of active bleeding (Fig 1).