Cardiology department, Lewisham Hospital NHS Trust, London, UK
Faculty of medicine and health sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
BMJ Case Rep. 2021 Aug 13;14(8):e244051. doi: 10.1136/bcr-2021-244051.
Spontaneous mesenteric bleeding is an exceptionally rare clinical condition and potentially lethal especially among elderly patients who are taking oral anticoagulant. We present a case of a 79-year-old woman who presented to the emergency department with atypical chest pain which was radiating to the back. She developed profound hypotension with a sudden drop of haemoglobin. Contrast-enhanced CT of the aorta showed active mesenteric bleeding with mesenteric haematoma. The early diagnosis relies solely on a high index of suspicion of occult bleeding in patients with unexplained hypotension with a sudden drop of haemoglobin. Troponin can be falsely positive in mesenteric bleeding. Close monitoring to detect any sign of deterioration and early imaging in diagnosing intra-abdominal bleeding can help to avoid delay in treatment which is essential to prevent mortality and morbidity.
自发性肠系膜出血是一种非常罕见的临床病症，尤其是对于正在服用口服抗凝剂的老年患者来说，可能是致命的。我们报告了一例 79 岁女性患者的病例，她因非典型胸痛就诊于急诊科，疼痛放射至背部。她出现严重低血压，血红蛋白突然下降。主动脉对比增强 CT 显示肠系膜出血合并肠系膜血肿。早期诊断仅依赖于对不明原因低血压伴血红蛋白突然下降的隐匿性出血的高度怀疑。肌钙蛋白在肠系膜出血时可能呈假阳性。密切监测任何恶化迹象，并及早进行影像学检查以诊断腹腔内出血，有助于避免治疗延误，这对于预防死亡率和发病率至关重要。
