Kula Joanna, Szmigiel Paweł, Rusinowski Cezary, Mrowiec Sławomir, Wosiewicz Piotr
Department of Internal, Autoimmune and Metabolic Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
Department of Digestive Tract Surgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
Medicine (Baltimore). 2025 May 30;104(22):e42428. doi: 10.1097/MD.0000000000042428.
Intramural hematoma of the large intestine is a rare and potentially life-threatening condition. Nonspecific clinical symptoms pose a diagnostic challenge, necessitating prompt recognition for timely and appropriate management. The selection of an optimal therapeutic approach depends on multiple factors, including the etiology and severity of bleeding, the patient's overall condition, and the availability of various treatment modalities.
This case report describes a 67-year-old male admitted for acute abdominal pain and hematochezia persisting for several hours.
Sigmoidoscopy revealed a large, smooth-walled, bluish-purple mass nearly occluding the rectum, suggestive of an intramural hematoma. Multidetector contrast-enhanced computed tomography of the abdomen and pelvis confirmed an extensive intramural hematoma of the rectum and sigmoid colon with active bleeding.
The patient underwent emergency surgery, during which the massive hematoma was evacuated. Hemostasis was achieved using seton placement and a diverting loop ileostomy. On postoperative day 2, the setons were removed, and reassessment confirmed the absence of active bleeding. The patient's condition gradually improved. Hematological parameters remained stable throughout the follow-up.
On the 10th postoperative day, the patient was discharged in good general condition with a well-healing surgical wound. Ileostomy reversal was performed 6 months after the initial hemorrhagic event, and the patient was subsequently discharged in good general condition without any complications and clinical consequences. An unconventional surgical strategy involving hematoma evacuation without intestinal resection preserved physiological bowel function, thereby preventing adverse clinical consequences.
This report highlights a case of extensive, spontaneous intramural hematoma of the rectum and sigmoid colon in a patient receiving anticoagulant therapy. Although rare, these hematomas should be considered in the differential diagnosis of abdominal pain in anticoagulated patients. A timely diagnosis based on clinical evaluation, thorough physical examination, and imaging studies is crucial for appropriate management. In this case, early diagnosis facilitated surgical intervention while preserving intestinal continuity.
大肠壁内血肿是一种罕见且可能危及生命的病症。非特异性临床症状带来诊断挑战，需要及时识别以便进行及时且恰当的治疗。最佳治疗方法的选择取决于多种因素，包括出血的病因和严重程度、患者的整体状况以及各种治疗方式的可用性。
本病例报告描述了一名67岁男性，因急性腹痛和便血持续数小时入院。
乙状结肠镜检查发现一个大的、壁光滑的蓝紫色肿物，几乎阻塞直肠，提示为壁内血肿。腹部和盆腔多排螺旋CT增强扫描证实直肠和乙状结肠广泛壁内血肿且有活动性出血。
患者接受了急诊手术，术中清除了巨大血肿。通过放置挂线和做转流性袢式回肠造口术实现了止血。术后第2天，拆除挂线，再次评估确认无活动性出血。患者病情逐渐好转。在整个随访过程中血液学参数保持稳定。
术后第10天，患者全身状况良好出院，手术伤口愈合良好。在最初出血事件发生6个月后进行了回肠造口还纳术，患者随后全身状况良好出院，无任何并发症和临床后果。一种不常规的手术策略，即不进行肠切除而清除血肿，保留了肠道生理功能，从而避免了不良临床后果。
本报告强调了一例接受抗凝治疗患者发生直肠和乙状结肠广泛自发性壁内血肿的病例。尽管罕见，但在抗凝患者腹痛鉴别诊断中应考虑这些血肿。基于临床评估、全面体格检查和影像学检查的及时诊断对于恰当治疗至关重要。在本病例中，早期诊断便于进行手术干预同时保留肠道连续性。
