SPONTANEOUS MESENTERIC HEMATOMA BY JEJUNAL ARTERY RUPTURE, COMPLICATION OF ORAL ANTICOAGULANT THERAPY, A CASE REPORT AND LITERATURE REVIEW
Abstract:
Mesenteric hematoma is a rare clinical condition often associated with abdominal
trauma. Non-traumatic mesenteric hematoma is a very rare condition, literature describing less
than 100 cases often associated with acute pancreatitis, visceral artery aneurysm rupture, systemic
inflammatory disease, and a complication of long term oral anticoagulant treatment. We present
the case of a 46-year old Caucasian man that was admitted to the acute surgical admission unit at
the County University Hospital Tîrgu-Mureş, România, for sudden-onset upper quadrant
abdominal pain. No history of abdominal trauma or systemic inflammatory disease was noted. A
subsequent therapy with Trombostop (warfarine, oral anticoagulant therapy) was prescribed one
year ago, for a cardiovascular disease. On admission, the patient had clinical signs of
hemorrhagic shock. Subsequent contrast abdominal computer tomography scans reveal a welldefined
ovoid mass in close relation to the small bowel tract measuring 12x 5.2x 3.3 cm, and leak
of contrast substance at the lower pole. The leak source was unclear but highly suggestive for an
emerging mesenteric trunk artery, possible one of the jejunal arteries. Median laparotomy was
performed and a large mesenteric hematoma caused by jejunal artery rupture was found and a
large volume of blood was removed from the peritoneal cavity (more than 2000 milliliters). Jejunal
resection was performed along with lateral jejunal anastomosis. Our case demonstrates that the
risk of bleeding in a patient taking anticoagulant treatment exist even if treatment is properly
administered.
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