Anagha Tirumalai Ramaswamy, Hassan Noor Ul
Department of General Surgery, Bangalore Medical College and Research Institute, Bengaluru, India.
SAGE Open Med Case Rep. 2025 Jun 20;13:2050313X251345933. doi: 10.1177/2050313X251345933. eCollection 2025.
Idiopathic spontaneous intraperitoneal haemorrhage, previously known as abdominal apoplexy, refers to bleeding into the peritoneal cavity due to the non-traumatic rupture of a visceral artery. It is a rare clinical condition that requires prompt diagnosis and management. The aetiology remains unclear, though factors such as atherosclerosis, coagulopathies, pancreatitis, malignancy and hypertension are often implicated. Very few cases have been reported where no clear aetiological cause could be identified. Here, we present the case of a 52-year-old man who was diagnosed with idiopathic spontaneous intraperitoneal haemorrhage and successfully managed conservatively. The diagnosis was confirmed through contrast-enhanced computed tomography and magnetic resonance imaging, which revealed a spontaneous mesenteric haematoma located in the right lumbar region with mild haemoperitoneum. The patient was managed with blood transfusion, IV fluids, and close monitoring; eventually, the haematoma showed signs of resolution and patient was discharged on day 10 and followed up on an outpatient basis till the haematoma completely resolved. This case report emphasis the need to maintain a high index of suspicion for spontaneous mesenteric haematoma in patients presenting with unexplained abdominal pain and haemodynamic instability, even in the absence of trauma as well as how unnecessary surgery can be avoided to reduce morbidity and improve recovery in carefully selected cases.
特发性自发性腹腔内出血，以前称为腹部卒中，是指由于内脏动脉非创伤性破裂导致血液流入腹腔。这是一种罕见的临床病症，需要及时诊断和处理。病因尚不清楚，尽管动脉粥样硬化、凝血功能障碍、胰腺炎、恶性肿瘤和高血压等因素常被牵连。极少有病例报道无法确定明确的病因。在此，我们报告一例52岁男性患者，其被诊断为特发性自发性腹腔内出血并成功接受保守治疗。通过增强计算机断层扫描和磁共振成像确诊，结果显示在右腰部有一个自发性肠系膜血肿并伴有轻度腹腔积血。患者接受了输血、静脉输液和密切监测；最终，血肿显示出吸收迹象，患者在第10天出院，并在门诊随访直至血肿完全吸收。本病例报告强调，对于出现不明原因腹痛和血流动力学不稳定的患者，即使没有创伤，也需要对自发性肠系膜血肿保持高度怀疑，以及在精心挑选的病例中如何避免不必要的手术以降低发病率并改善恢复情况。
