Perspectives and Management Strategies for Acute Colonic Intramural Hematoma

Abstract

Acute intramural hematoma of the colon is a rarely encountered clinical condition with diverse precipitating factors. Different acute and chronic complications emerge following hematoma formation, mandating high clinical suspicion for early diagnosis and optimum management. CECT represents the cornerstone for the proper demonstration of colonic hematomas and possible detection of complications as well as the underlying etiology. There are multiple strategies for management of intramural hematoma and treatment should be tailored according to the etiology and the clinical condition of the patient, reserving surgical intervention for unstable or complicated cases. Endoscopic management of colonic hematomas offers a promising minimally invasive modality with potential safety and efficacy.

A Case of Idiopathic Colonic Intramural Hematoma: Successful Expectant Management

“…Intramural hematoma may occur through the gastrointestinal tract, and the intestinal areas at the intersection of retroperitoneally fixed and non-fixed were the most typically impacted. The duodenum was the most typically implicated bowel area with traumatic acute intramural hematoma, followed by the ascending colon/caecum [ 3 , 4 ]. Isolated colon involvement is rare owing to the protective role of teniae coli, which usually inhibits the distribution of bleeding in the intestinal wall [ 1 , 6 ].…”

“…Intramural gastrointestinal hematomas are rare; colonic involvement is sporadic, with very few published reports [ 1 , 2 ]. The explanation for this rarity is thought to be the protective function of taenia coli, which can prevent blood from diffusing into the intestinal wall if intramural arteries burst owing to physical trauma [ 3 ]. Radiological imaging, particularly CT scans with intravenous and oral contrast administration, may be used to diagnose accurately [ 3 ].…”

“…The explanation for this rarity is thought to be the protective function of taenia coli, which can prevent blood from diffusing into the intestinal wall if intramural arteries burst owing to physical trauma [ 3 ]. Radiological imaging, particularly CT scans with intravenous and oral contrast administration, may be used to diagnose accurately [ 3 ]. In the past, most patients with colonic intramural hematoma were surgically treated (laparoscopy or open procedures) [ 4 ].…”

“…Intramural hematomas can induce partial or full bowel blockage, and surgical therapy should be considered in patients who have intestinal necrosis, peritonitis, or a deteriorating overall status despite conservative treatments. Early diagnosis and treatment of hematoma can help to avoid intestinal blockage and surgery [ 3 ]. Herein, we present an idiopathic colonic intramural hematoma case in a 29-year-old female patient with an atypical clinical presentation.…”

Colonic Intramural Hematoma in a Cat: A Case Report

“…Colonic intramural hematoma is rare in humans and animals and occurs mostly secondary to blunt abdominal trauma, anticoagulant therapy, coagulopathies, or intestinal neoplasia in humans (1). In humans, spontaneous colonic hematoma is most commonly associated with blunt trauma (2). Risk factors include bleeding diathesis, such as those experienced by patients undergoing anticoagulant therapy or with coagulopathies (3).…”