Bekki Tomoaki, Yano Takuya, Okuda Hiroshi, Egi Hiroyuki, Yonehara Shuji, Amano Hironobu, Noriyuki Toshio, Nakahara Masahiro
Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
Int J Surg Case Rep. 2019;56:20-24. doi: 10.1016/j.ijscr.2019.02.007. Epub 2019 Feb 12.
A spontaneous mesenteric hematoma is rare, and its etiology is unclear. We present a very rare case of spontaneous mesenteric hematoma with a fistula to the transverse colon.
A 90-year-old male visited our hospital because of lower abdominal pain. The physical examination revealed tenderness in the lower abdomen. The laboratory data revealed anemia and low estimated glomerular filtration rate (eGFR). The abdominal contrast-enhanced computerized tomography (CT) indicated a mass with coexisting low- and high-density areas adjacent to the transverse colon. The mass was diagnosed as a mesenteric hematoma. We selected conservative therapy, because the patient's condition was stable. After 15 days from discharge, he was admitted to the hospital again for the complaint of bloody stool. A fistula with blood flowing out at the splenic flexure was reported on colonoscopy. In the laparoscopic operative findings, the hematoma adhered to the stomach, pancreas and omentum. A hand-assisted laparoscopic transverse colectomy including hematoma in the mesentery was successful. The pathological reports revealed that a spontaneous mesenteric hematoma formed the fistula to the colon. The patient was discharged without any postoperative complication on day 10.
Generally, laparotomy is often chosen for the treatment of mesenteric hematoma. The laparoscopic approach for mesenteric hematoma is useful under the specific condition that the preoperative patient's condition is stable.
This is the first case of a spontaneous mesenteric hematoma with a fistula to the colon resected safely by laparoscopic surgery.
自发性肠系膜血肿较为罕见，其病因尚不清楚。我们报告一例极为罕见的自发性肠系膜血肿合并与横结肠形成瘘管的病例。
一名90岁男性因下腹部疼痛前来我院就诊。体格检查发现下腹部压痛。实验室检查显示贫血且估算肾小球滤过率（eGFR）较低。腹部增强计算机断层扫描（CT）显示在横结肠附近有一个同时存在低密度和高密度区域的肿块。该肿块被诊断为肠系膜血肿。由于患者病情稳定，我们选择了保守治疗。出院15天后，他因便血再次入院。结肠镜检查报告显示在脾曲处有一个有血液流出的瘘管。在腹腔镜手术所见中，血肿与胃、胰腺和网膜粘连。成功实施了包括肠系膜血肿在内的手辅助腹腔镜横结肠切除术。病理报告显示自发性肠系膜血肿形成了与结肠的瘘管。患者在术后第10天无任何并发症出院。
一般来说，肠系膜血肿的治疗常选择剖腹手术。在术前患者病情稳定的特定情况下，腹腔镜治疗肠系膜血肿是有用的。
这是首例通过腹腔镜手术安全切除的合并与结肠形成瘘管的自发性肠系膜血肿病例。
