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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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Intraoperative image of mid-jejunal mesenteric haematoma.
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Figure 3: Intraoperative image of mid-jejunal mesenteric haematoma.

Mentions: Subsequent laparotomy identified a grossly dilated segment of ileum proximal to a terminal ileal stricture. There was also a large haematoma within the mesentery of the mid-jejunum that corresponded to the mass demonstrated on CT (Figure 3). There was no evidence of local vascular trauma or pancreatico-biliary inflammation. The loop of jejenum was viable and macroscopically normal without any associated signs of Crohn’s disease. The remainder of the small and large bowel also appeared normal. The patient underwent a limited right hemicolectomy and double barrel stoma formation from the ileum and ascending colon. After surgery she was placed on an enhanced recovery protocol and was discharged on the 5th post-operative day. She is currently well and to date her follow-up has remained un-eventful.


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)

Intraoperative image of mid-jejunal mesenteric haematoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Intraoperative image of mid-jejunal mesenteric haematoma.
Mentions: Subsequent laparotomy identified a grossly dilated segment of ileum proximal to a terminal ileal stricture. There was also a large haematoma within the mesentery of the mid-jejunum that corresponded to the mass demonstrated on CT (Figure 3). There was no evidence of local vascular trauma or pancreatico-biliary inflammation. The loop of jejenum was viable and macroscopically normal without any associated signs of Crohn’s disease. The remainder of the small and large bowel also appeared normal. The patient underwent a limited right hemicolectomy and double barrel stoma formation from the ileum and ascending colon. After surgery she was placed on an enhanced recovery protocol and was discharged on the 5th post-operative day. She is currently well and to date her follow-up has remained un-eventful.

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