Spontaneous mesenteric hematoma after antiplatelet therapy: a case report

Abstract

Spontaneous mesenteric hematoma (SMH) is one of the rare conditions with abdominal mass secondary to hemorrhage. It develops due to regional bleeding in the mesenteric vessel of a gastrointestinal tract. The unusual morphology and lack of apparent etiology of SMH make it difficult to diagnose. A 57-year-old woman was referred to our hospital for intermittent abdominal pain with nausea and vomiting. She was receiving antiplatelet therapy by aspirin from idiopathic thrombocytosis. The number of platelet was above the normal level. CT showed a tumor-like lesion with arterial extravasation in the left lower abdomen. Mesenteric hematoma was considered since the mass was located between two branches of inferior sigmoid artery (IMA). Emergency laparotomy was performed and a mesenteric hematoma adjacent to the sigmoid colon was identified. The mesenteric hematoma was resected with the regional sigmoid colon. Pathology report showed intact mucous membrane of the excision without tumors or aneurysm. SMH was finally confirmed. The patient returned to her daily life without complaining of any symptoms. When a patient on antiplatelet therapy complained of acute abdominal pain, SMH has to be taken into consideration. Abdominopelvic CT scan is an effective investigation for diagnosis, and conservative therapy or emergent exploratory laparotomy could be an optional treatment. To the best of our research in Medline, there have only seven cases of colorectal SMH. Authors reportrd a rare case of SMH located at sigmoid colon, which appeared after antiplatelet therapy.

Spontaneous mesenteric haematoma: a complication of oral anticoagulant use

“…(6) However, Liang et al considered SMHs as those occurring in patients with risk factors such as connective tissue disorders, coagulopathies and those without any identifiable cause (idiopathic). (7) Hirano et al further classified mesenteric haematomas into traumatic and non-traumatic -which are associated with mesenteric vascular diseases such as vasculitis -and spontaneous, which may be associated with anticoagulation therapy, connective tissue disease and other diseases such as Crohn's disease. Further clarity on the exact definition of mesenteric haematomas is warranted.…”

“…Aoki et al (13) reported ten cases of SMH. Liang et al (7) reported another case series of 20 patients with SMH, 17 of whom were diagnosed after the publication of the paper by Aoki et al In the paper by Liang et al, five of the patients had been on warfarin and two had been on aspirin. However, only one case of SMH associated with NOAC use has been reported so far, by Hirano et al (2) In this case, a tear in the sigmoid colon mesentery resulted in bleeding and subsequent formation of mesenteric haematoma.…”

“…Complications that can arise from spontaneous mesenteric haematoma include partial or complete bowel obstruction, bowel ischaemia secondary to compromised blood supply within the mesentery, (7,8) and infection of haematoma.…”