Mesenteric hematoma is a rare condition resulting from localized bleeding in peripheral mesenteric vessels that is generally caused by abdominal trauma, postoperative complications, or aneurysm.⁵ The most common clinical symptom is abdominal pain, the severity of which depends on the location and size of hematoma. Nausea or constipation may occur if the tumor is large enough to compress the digestive tract. ^6-7 Nonspecific symptoms make it difficult to reach a diagnosis and Mesenteric Hematoma is usually identified by history, abdominal contrast enhanced CT, ultrasound, or magnetic resonance imaging (MRI). ⁸This is a case that demonstrates the use of non-operative management in a clinically stable patient in which neither CT scanning nor visceral angiography could identify any active bleeding or cause for hemorrhage. Previous cases have also highlighted the importance of non-operative management and avoidance of emergency laparotomy in stable patients.⁹ Regular imaging and clinical follow-up is required to make sure the hematoma is reducing in size and the patient remains well.

Management of patients with mesenteric hematoma depends on their clinical stability. Patients in shock not responding to fluid resuscitation need an emergency operation. Patients stable after resuscitation require urgent imaging. CT scanning is the standard imaging modality. CT is required to rule out other more common causes of abdominal pain and shock; including abdominal aneurysm, malignancy and acute pancreatitis. These diagnoses are more common than spontaneous mesenteric hemorrhage. CT reports must be interpreted with caution. Cases have been reported where the laparotomy has been performed after CT misdiagnosis when; mass lesions have been reported on scans that have not been confirmed at laparotomy. ^5-8 If the patient is stable and the CT is suggestive of a mesenteric hematoma; selective visceral angiography should be performed. Where possible, bleeding vessels should be embolised. ⁹ Recent studies have shown embolization to be successful in the treatment of ruptured aneurysm secondary to pancreatitis and in postoperative bleeding events.^10-11 Only tertiary centres provide this service; fast diagnosis and transfer from district general hospitals are therefore indicated.