A rare case of haemorrhagic shock secondary to spontaneous rupture of a branch of the left colic artery and the right gastric artery

Spontaneous mesenteric hematoma occurring during antithrombotic therapy and responsive to surgical treatment: a case report

BACKGROUND

Spontaneous mesenteric hematoma is a rare condition that is diagnosed when clinical and pathological findings do not identify an obvious causative disease. Various treatment options for spontaneous mesenteric hematoma exist; however, there are no clear treatment criteria. Herein, we report a case of spontaneous mesenteric hematoma that was successfully treated surgically and discuss the optimum treatment strategy based on similar cases.

CASE PRESENTATION

A 63-year-old man with abdominal persisting for 3 days presented to our hospital after going into shock without any triggers. The patient had a history of atrial fibrillation, stroke, and an aneurysm, and was receiving antithrombotic therapy. Abdominal contrast-enhanced computed tomography revealed a mass structure within the sigmoid mesentery, which was suspected to be a hematoma. The patient was admitted to the hospital for follow-up observation after initial infusion and vital stabilization. However, the following day, the patient developed acute generalized peritonitis with necrosis of the sigmoid colon; therefore, emergency Hartmann's surgery was performed. Intraoperative and histopathological examinations revealed no evidence of bleeding.

CONCLUSION

Spontaneous mesenteric hematomas tend to be associated with intestinal necrosis and may require surgical treatment with bowel resection owing to the difficulty in identifying the responsible vessel. Moreover, our results suggest that the presence of antithrombotic therapy may be an important factor affecting spontaneous mesenteric hematoma development.

Surgical Excision of a Contained Rupture of an Inferior Mesenteric Aneurysm

Inferior mesenteric artery (IMA) aneurysms represent the minority of visceral aneurysm presentations. A 57-year-old female was admitted with a symptomatic IMA aneurysm secondary to atherosclerotic disease. She was treated with open excision which revealed a contained ruptured of a true aneurysm. This case highlights the challenges of an accurate preoperative diagnosis of IMA aneurysm and the correct position of the recent guidelines on visceral aneurysms issued by the Society of Vascular Surgery (SVS).