Spontaneous Mesenteric Hematoma with Duodenal Stenosis

Ono, Hideki; Tasaki, Takako; Tanahashi, Jin; Murakami, Kazunari

doi:10.2169/internalmedicine.52.0089

Cited by 7 publications

(5 citation statements)

References 1 publication

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“…However, duodenal stenosis caused by compression of the mesenteric hematoma is rare. Although some cases of duodenal intramural hematomas or retroperitoneal hematomas have been reported ( 2 , 3 ), only one report of stenosis caused by compression with mesenteric hematoma is available in English ( 6 ). The horizontal and ascending parts of the duodenum are attached to the back of the abdominal wall.…”

Section: Discussionmentioning

confidence: 99%

Benign Duodenal Stenosis Caused by Huge Mesenteric Hematoma Conservatively Improved with Long-term Use of Double Elementary Diet Tube

et al. 2022

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Mesenteric hematoma is an uncommon condition caused by focal bleeding in the mesenteric vessels. Hematomas are related to trauma, pancreatitis, arteriopathy, and the use of antithrombotic agents. Although hematomas cause intestinal stenosis by compressing the adjacent small bowel, duodenal stenosis due to hematoma is rare. Therefore, the treatment indications for cases of hematoma with stenosis have not been established. We herein report a case with a large mesenteric hematoma that caused duodenal stenosis by compressing the third portion of the duodenum. Stenosis was successfully ameliorated after long-term use of a double elementary diet tube.

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Section: Discussionmentioning

confidence: 99%

Benign Duodenal Stenosis Caused by Huge Mesenteric Hematoma Conservatively Improved with Long-term Use of Double Elementary Diet Tube

et al. 2022

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“…The intra-abdominal adhesions observed intra-operatively caused the small bowel obstruction after leakage of the hematoma into the intra-abdominal cavity. Previous studies have reported on small bowel obstruction [ 5 , 7 ] or duodenal stenosis [ 6 ] caused by a non-traumatic mesenteric hematoma. In these cases, however, the obstruction was caused by direct compression of the gastrointestinal tract by the hematoma.…”

Section: Discussionmentioning

confidence: 99%

Abdominal complications due to collapse of a large mesenteric hematoma after rupture of a right colic artery aneurysm: a case report

et al. 2021

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Background Non-traumatic mesenteric hematomas are usually well controlled, with no resulting symptoms. Herein, we report a case in which collapse of a large mesenteric hematoma, after rupture of a right colic artery aneurysm, caused small bowel obstruction and rapid absorption of the hematoma contributed to cholestasis. Case presentation A-44-year-old man presented with a sudden onset of severe right lower abdominal pain. Computed tomography (CT) revealed rupture of a right colic artery aneurysm and intra-abdominal bleeding. After embolization of the right colic artery aneurysm, a large mesenteric hematoma remained. As the patient had no symptoms, we elected to pursue conservative treatment. However, on day 16 post-onset, he developed right lower abdominal pain. On CT imaging, partial collapse of the wall of the residual mesenteric hematoma was observed, with visible leakage from the hematoma into the abdominal cavity, resulting in small bowel obstruction and cholestasis. Symptoms did not improve with conservative treatment, and we proceeded to surgical treatment on day 32 after onset. Intra-operatively, adhesions between the small bowel and the abdominal wall were identified and caused the small bowel obstruction. We proceeded with removing these adhesions and as much of the hematoma as possible. Although the small bowel obstruction improved after surgery, cholecystitis developed, and percutaneous transhepatic gallbladder aspiration was performed on day 45. The patient was discharged on day 70. Conclusions Collapse of a mesenteric hematoma can cause small bowel obstruction. Rapid absorption of the hematoma due to the collapse might contribute to cholestasis. A large abdominal hematoma might be a risk factor for failure of conservative treatment, and surgery might be required due to abdominal complications.

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“…To the best of our knowledge, only 10 reported cases of SHM accompanied by comprehensive and publicly available data appear by MEDLINE searching of English literature (Table 1) [8][9][10][11][12][13][14][15][16][17], and 5 of these were reported from Asia. Together, these cases reveal two important findings; it is relatively easy to reach the diagnosis of hematoma in the early phase from onset, and aspiration biopsy should not be performed for the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

A case of spontaneous mesenteric hematoma with diagnostic difficulty

et al. 2020

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Background Spontaneous mesenteric hematoma (SMH) is a rare condition characterized by intraperitoneal hemorrhage of unknown etiology. SMH without worsening of general status allows conservative management; however, patients showing chronological changes on imaging require surgical intervention to rule out possible malignancy. Case presentation A 69-year-old man was referred to our hospital to evaluate an abdominal mass with no associated clinical symptoms. He had a history of chronic hepatitis C and diabetes mellitus. Six months earlier, computed tomography (CT) revealed a 75-mm tumor arising from the jejunum, suspected to be a gastrointestinal stromal tumor (GIST) of the small intestine. Following a further 6 months of observation, the patient was referred to our hospital. Abdominal contrast-enhanced CT revealed a well-defined heterogeneous round tumor with a maximum diameter of 75 mm adjacent to the upper jejunum. The tumor was accompanied by calcification at the periphery, with no evidence of augmentation over the prior 6 months. Diffuse lymphadenopathy was observed around the aorta and splenic artery. Under the diagnosis of GIST arising from small intestine, the patient underwent elective surgery. The resection revealed an elastic soft tumor at the mesentery adjacent to the upper jejunum with severe adhesion between the tumor and jejunum. The tumor origin was unclear; thus, we performed mesenteric excision and partial enterectomy without lymph node dissection. The tumor was surrounded by fibrous capsular tissue containing massive hemosiderin deposits and cholesterol crystals showing partial calcification, resulting in a diagnosis of spontaneous hematoma of the mesentery. Conclusions We report a case of SMH mimicking small intestinal GIST. It is difficult to diagnose long-established SMH because its radiological features change with time, and more case reports are needed to improve the accuracy of diagnosis.

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Spontaneous Mesenteric Hematoma with Duodenal Stenosis

Cited by 7 publications

References 1 publication

Benign Duodenal Stenosis Caused by Huge Mesenteric Hematoma Conservatively Improved with Long-term Use of Double Elementary Diet Tube

Benign Duodenal Stenosis Caused by Huge Mesenteric Hematoma Conservatively Improved with Long-term Use of Double Elementary Diet Tube

Abdominal complications due to collapse of a large mesenteric hematoma after rupture of a right colic artery aneurysm: a case report

A case of spontaneous mesenteric hematoma with diagnostic difficulty

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