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Spontaneous mesenteric hematoma complicating an exacerbation of Crohn's disease: report of a case.

Ashrafian H, Manfield JH, Mitra A, Boyle DJ, Mathur P - BMC Surg (2014)

Bottom Line: Spontaneous mesenteric haematoma is a rare condition that occurs due to localized bleeding in the mesenteric vascular tree of a bowel segment in the absence of an identifiable cause.The patient underwent surgical management for small bowel obstruction secondary to Crohn's disease, however the concurrent presence of a spontaneous mesenteric haematoma in the mid-jejunal mesentery was successfully managed conservatively.This case identifies the first association of spontaneous mesenteric haematoma with an exacerbation of Crohn's disease and highlights the need to consider rare differential diagnoses such as SMH when performing radiological assessment of unexplained symptoms in inflammatory bowel disease patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Barnet Hospital, Barnet and Chase Farm Hospitals NHS Trust, Wellhouse Lane, Barnet EN5 3DJ, UK. h.ashrafian@imperial.ac.uk.

ABSTRACT

Case presentation: Spontaneous mesenteric haematoma is a rare condition that occurs due to localized bleeding in the mesenteric vascular tree of a bowel segment in the absence of an identifiable cause. Here we report a case of spontaneous mesenteric haematoma during an inflammatory exacerbation of Crohn's disease. The patient underwent surgical management for small bowel obstruction secondary to Crohn's disease, however the concurrent presence of a spontaneous mesenteric haematoma in the mid-jejunal mesentery was successfully managed conservatively.

Conclusion: This case identifies the first association of spontaneous mesenteric haematoma with an exacerbation of Crohn's disease and highlights the need to consider rare differential diagnoses such as SMH when performing radiological assessment of unexplained symptoms in inflammatory bowel disease patients.

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Related in: MedlinePlus

Computed tomography (CT) scan demonstrating small bowel obstruction and mesenteric haematoma taken at the same anatomical level as Figure1b.
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Figure 2: Computed tomography (CT) scan demonstrating small bowel obstruction and mesenteric haematoma taken at the same anatomical level as Figure1b.

Mentions: A 44-year-old female presented with an exacerbation of Crohn’s disease that was not responsive to medical management with escalating steroid (prednisolone) and purine analogue (azathioprine) therapy. She was a non-smoker and aside from well-controlled essential hypertension had no other significant co-morbidities. Her inflammatory bowel disease had already required two previous hospitalizations, and she had suffered from symptoms of intermittent pain and bloating with constipation throughout the 12 months since her diagnosis. In the preceding month a computed tomography (CT) scan revealed 3 segments of Crohn’s disease strictures with prestenotic dilatation and an inflammatory appearance (Figure 1a). No mesenteric haematoma was identified at this point (Figure 1b). Blood tests taken at this time were unremarkable with a haemaglobin (Hb) of 11.7 g/dl, white cell count (WCC) of 5.4 × 109/L and a C-reactive protein (CRP) of 7 mg/L. Her symptoms initially resolved with intravenous hydrocortisone but promptly recurred with worsening malnutrition despite intensifying steroid therapy. She had not received any formal anticoagulation other than prophylactic subcutaneous low-molecular weight heparin (20 mg once daily) during the period of her hospitalization. Repeat CT scan (Figure 2) demonstrated a significant deterioration in small bowel dilatation with impending obstruction due to a 10 cm distal ileal stricture and a left upper quadrant abdominal ‘mass’ (9 × 12 × 20 cm), thought to be an inflammatory phlegmon secondary to an area of more proximal Crohn’s disease. Repeat blood tests at this time revealed anaemia with a haemaglobin of 8.6 g/dl, a normal WCC of 6.5 × 109/L and a CRP of 25 mg/L. No clotting abnormalities were identified and liver function tests were unremarkable.


Spontaneous mesenteric hematoma complicating an exacerbation of Crohn's disease: report of a case.

Ashrafian H, Manfield JH, Mitra A, Boyle DJ, Mathur P - BMC Surg (2014)

Computed tomography (CT) scan demonstrating small bowel obstruction and mesenteric haematoma taken at the same anatomical level as Figure1b.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061510&req=5

Figure 2: Computed tomography (CT) scan demonstrating small bowel obstruction and mesenteric haematoma taken at the same anatomical level as Figure1b.
Mentions: A 44-year-old female presented with an exacerbation of Crohn’s disease that was not responsive to medical management with escalating steroid (prednisolone) and purine analogue (azathioprine) therapy. She was a non-smoker and aside from well-controlled essential hypertension had no other significant co-morbidities. Her inflammatory bowel disease had already required two previous hospitalizations, and she had suffered from symptoms of intermittent pain and bloating with constipation throughout the 12 months since her diagnosis. In the preceding month a computed tomography (CT) scan revealed 3 segments of Crohn’s disease strictures with prestenotic dilatation and an inflammatory appearance (Figure 1a). No mesenteric haematoma was identified at this point (Figure 1b). Blood tests taken at this time were unremarkable with a haemaglobin (Hb) of 11.7 g/dl, white cell count (WCC) of 5.4 × 109/L and a C-reactive protein (CRP) of 7 mg/L. Her symptoms initially resolved with intravenous hydrocortisone but promptly recurred with worsening malnutrition despite intensifying steroid therapy. She had not received any formal anticoagulation other than prophylactic subcutaneous low-molecular weight heparin (20 mg once daily) during the period of her hospitalization. Repeat CT scan (Figure 2) demonstrated a significant deterioration in small bowel dilatation with impending obstruction due to a 10 cm distal ileal stricture and a left upper quadrant abdominal ‘mass’ (9 × 12 × 20 cm), thought to be an inflammatory phlegmon secondary to an area of more proximal Crohn’s disease. Repeat blood tests at this time revealed anaemia with a haemaglobin of 8.6 g/dl, a normal WCC of 6.5 × 109/L and a CRP of 25 mg/L. No clotting abnormalities were identified and liver function tests were unremarkable.

Bottom Line: Spontaneous mesenteric haematoma is a rare condition that occurs due to localized bleeding in the mesenteric vascular tree of a bowel segment in the absence of an identifiable cause.The patient underwent surgical management for small bowel obstruction secondary to Crohn's disease, however the concurrent presence of a spontaneous mesenteric haematoma in the mid-jejunal mesentery was successfully managed conservatively.This case identifies the first association of spontaneous mesenteric haematoma with an exacerbation of Crohn's disease and highlights the need to consider rare differential diagnoses such as SMH when performing radiological assessment of unexplained symptoms in inflammatory bowel disease patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Barnet Hospital, Barnet and Chase Farm Hospitals NHS Trust, Wellhouse Lane, Barnet EN5 3DJ, UK. h.ashrafian@imperial.ac.uk.

ABSTRACT

Case presentation: Spontaneous mesenteric haematoma is a rare condition that occurs due to localized bleeding in the mesenteric vascular tree of a bowel segment in the absence of an identifiable cause. Here we report a case of spontaneous mesenteric haematoma during an inflammatory exacerbation of Crohn's disease. The patient underwent surgical management for small bowel obstruction secondary to Crohn's disease, however the concurrent presence of a spontaneous mesenteric haematoma in the mid-jejunal mesentery was successfully managed conservatively.

Conclusion: This case identifies the first association of spontaneous mesenteric haematoma with an exacerbation of Crohn's disease and highlights the need to consider rare differential diagnoses such as SMH when performing radiological assessment of unexplained symptoms in inflammatory bowel disease patients.

Show MeSH
Related in: MedlinePlus