Small bowel hematoma in a hemophiliac as a cause of pseudoappendicitis: diagnosis by CT imaging.

Acute abdominal pain in a hemophiliac should be approached as hemorrhage until proven otherwise. With factor replacement available, a conservative approach can be taken as opposed to immediate exploratory surgery. Diagnostic imaging can define areas of hemorrhage. We report a case of "pseudoappendicitis" in a hemophiliac with terminal ileum circumferential bowel wall hematoma diagnosed by CT with the initial diagnostic scan. Factor replacement resulted in resolution of the signs and symptoms of the pseudoappendicitis and follow-up CT scan revealed resolution of the hematoma. A review of the literature reveals few CT documented circumferential bowel wall hematomas with limited clinical histories and no cases with follow-up scans after conservative management.