Abdominal CT in a pregnant woman: Bane or boon?

Would you ever purposefully advise an abdominal computed tomography scan in a pregnant woman? We present the case of a pregnant woman who presented with hematochezia requiring multiple transfusions.

Case

A 25‐year‐old female at 30 weeks of gestation presented with a history of intermittent hematochezia for 2 months. She also had dyspnea on exertion and palpitations. She had a history of six units of blood transfusion in the last 2 weeks. Physical examination revealed severe pallor. Her hemoglobin was 7.9 gm/dL. Upper gastrointestinal endoscopy was normal. Colonoscopy with terminal ileoscopy showed normal terminal ileum but altered blood in the ascending and transverse colon. Ultrasound abdomen was unremarkable except for gravid uterus. The patient continued to have hematochezia with further requirements of 2 units of blood transfusion while in hospital, and thus, a CT scan was advised. The CT scan with angiography revealed a small area of tortuous vessel with arterial enhancement along the mesenteric border of the ascending colon, which showed progressive enhancement with arterial supply from ileocolic branch of the superior mesenteric artery and the early draining vein into superior mesenteric vein (Fig. 1a,b). These findings were suggestive of colonic angiodysplasia or arteriovenous malformation. She underwent right hemicolectomy, after which her bleeding stopped. Gross examination of the resected specimen showed a 2 × 1.5‐cm area of mucosal discoloration with prominent tortuous blood vessels (Fig. S1a, Supporting information). Histopathological examination showed multiple dilated and tortuous blood vessels spurting in the mucosa and a few in the submucosa and also showed lamina propria showing mixed inflammatory infiltrate with submucosal edema and hemorrhage (Fig. S1b). These findings were consistent with angiodysplasia. She delivered a healthy baby 6 weeks later.

Figure 1

(a) Computed tomography (CT) abdomen and (b) CT angiography showing an area of tortuous vessel with arterial enhancement (arrow) along the mesenteric border of the ascending colon, which showed arterial supply from ileocolic branch of superior mesenteric artery and early draining vein into superior mesenteric vein, suggestive of colonic angiodysplasia or arteriovenous malformation.

Although colonic angiodysplasia is a well‐recognized cause of hematochezia in the general population with risk factors that include older age, chronic kidney diseases, and cardiovascular diseases, this is the first‐ever report of such a lesion in a pregnant woman. Management options include pharmacotherapy, endoscopic intervention, angioembolization, and surgery. An abdominal CT scan, although contraindicated in pregnancy, proved to be a boon for this patient, diagnosing the cause of her gastrointestinal bleed and guiding the definitive therapy.

Figure S1 (A) Resected specimen showing an area of mucosal discoloration with tortuous prominent blood vessels (arrow). (B) Histopathological examination showing multiple dilated and tortuous blood vessels (arrow) spurting in mucosa and lamina propria showing mixed inflammatory infiltrate with submucosal edema and hemorrhage.

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