Hirano Katsuhisa, Bando Tadashi, Osawa Soshi, Shimizu Tetsuro, Okumura Tomoyuki, Fujii Tsutomu
Department of Surgery, Saiseikai Toyama Hospital, 33-1, Kusunoki, Toyama city, Toyama, 931-8533, Japan.
Department of Surgery and Sciences, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, 2630, Sugitani, Toyama city, Toyama, 930-0194, Japan.
Int J Surg Case Rep. 2018;44:33-37. doi: 10.1016/j.ijscr.2018.02.008. Epub 2018 Feb 10.
Mesenteric hematoma is a rare condition caused by bleeding localized in the mesenteric vascular tree. This is a first report of spontaneous mesenteric hematoma caused by rivaroxaban.
The patient was a 71-year-old man who had taken rivaroxaban for paroxysmal atrial fibrillation. He had experienced abdominal pain and diarrhea for the prior 3 days. He had little melena and was referred to our institute. He presented with hypotension on arrival. Computed tomography (CT) revealed a 10 cm mass in the mesentery of the sigmoid colon with extravasation. Active bleeding from the sigmoid colic arteries was embolized with angiography on the day of admission. On the second day, we operated on the patient. We detected 200 mL of bloody ascites accumulated in the abdomen. The serosa of the sigmoid colon was ruptured along the tenia due to the compression of the hematoma in the mesentery. The sigmoid colon was resected and a descending colostomy was reconstructed. Operative and pathological findings did not reveal the cause of bleeding. We finally diagnosed the patient with spontaneous mesenteric hematoma associated with rivaroxaban.
Previous reports of mesenteric hematoma with anticoagulant were associated with warfarin. Since rivaroxaban is not affect to the value of prothrombin time (PT) and activated partial thromboplastin time (APTT) and mesenteric hematoma presents non-specific symptoms, it is difficult to diagnose mesenteric hematoma in the patients taking rivaroxaban.
It is important to keep in mind that mesenteric hematoma is one of the critical complications in patients taking rivaroxaban.
肠系膜血肿是一种罕见的疾病，由肠系膜血管树局部出血引起。这是关于利伐沙班导致自发性肠系膜血肿的首例报告。
患者为一名71岁男性，因阵发性心房颤动服用利伐沙班。他在之前3天出现腹痛和腹泻。有少量黑便，遂转诊至我院。入院时出现低血压。计算机断层扫描（CT）显示乙状结肠系膜有一个10厘米的肿块并有造影剂外渗。入院当天通过血管造影栓塞了乙状结肠动脉的活动性出血。第二天，我们对患者进行了手术。我们发现腹腔内积聚了200毫升血性腹水。由于肠系膜血肿的压迫，乙状结肠的浆膜沿结肠带破裂。切除乙状结肠并重建降结肠造口术。手术和病理检查结果未揭示出血原因。我们最终诊断该患者为与利伐沙班相关的自发性肠系膜血肿。
先前关于抗凝剂导致肠系膜血肿的报告与华法林有关。由于利伐沙班不影响凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）的值，且肠系膜血肿表现为非特异性症状，因此在服用利伐沙班的患者中难以诊断肠系膜血肿。
必须牢记，肠系膜血肿是服用利伐沙班患者的严重并发症之一。
