Aoki Meiko, Yoshii Hisamichi, Fujino Rika, Izumi Hideki, Mukai Masaya, Makuuchi Hiroyasu
Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawacho, Hachioji City, Tokyo, 192-0032, Japan.
Surg Case Rep. 2024 Aug 16;10(1):188. doi: 10.1186/s40792-024-01993-9.
Spontaneous mesenteric hematoma is a rare condition that is diagnosed when clinical and pathological findings do not identify an obvious causative disease. Various treatment options for spontaneous mesenteric hematoma exist; however, there are no clear treatment criteria. Herein, we report a case of spontaneous mesenteric hematoma that was successfully treated surgically and discuss the optimum treatment strategy based on similar cases.
A 63-year-old man with abdominal persisting for 3 days presented to our hospital after going into shock without any triggers. The patient had a history of atrial fibrillation, stroke, and an aneurysm, and was receiving antithrombotic therapy. Abdominal contrast-enhanced computed tomography revealed a mass structure within the sigmoid mesentery, which was suspected to be a hematoma. The patient was admitted to the hospital for follow-up observation after initial infusion and vital stabilization. However, the following day, the patient developed acute generalized peritonitis with necrosis of the sigmoid colon; therefore, emergency Hartmann's surgery was performed. Intraoperative and histopathological examinations revealed no evidence of bleeding.
Spontaneous mesenteric hematomas tend to be associated with intestinal necrosis and may require surgical treatment with bowel resection owing to the difficulty in identifying the responsible vessel. Moreover, our results suggest that the presence of antithrombotic therapy may be an important factor affecting spontaneous mesenteric hematoma development.
自发性肠系膜血肿是一种罕见病症，当临床和病理检查结果未发现明显致病疾病时可作出诊断。对于自发性肠系膜血肿存在多种治疗选择；然而，尚无明确的治疗标准。在此，我们报告一例经手术成功治疗的自发性肠系膜血肿病例，并基于类似病例讨论最佳治疗策略。
一名63岁男性，腹部持续疼痛3天，在无任何诱因进入休克状态后被送往我院。该患者有房颤、中风和动脉瘤病史，正在接受抗血栓治疗。腹部增强CT显示乙状结肠系膜内有一肿块结构，怀疑为血肿。患者在初始输液和生命体征稳定后入院进行随访观察。然而，第二天，患者出现急性弥漫性腹膜炎伴乙状结肠坏死；因此，进行了急诊Hartmann手术。术中及组织病理学检查未发现出血迹象。
自发性肠系膜血肿往往与肠坏死相关，由于难以确定责任血管，可能需要行肠切除手术治疗。此外，我们的结果表明抗血栓治疗的存在可能是影响自发性肠系膜血肿发生的一个重要因素。
