DISCUSSION
Mesenteric hematoma is a rare condition due to a localized bleeding from peripheral mesenteric vessels that is generally caused by abdominal trauma, postoperative complications, or aneurysm [6]. The most common clinical symptom is abdominal pain, the severity of which depends on the location and size of the hematoma. Nausea or constipation may occur if the tumor is large enough to compress the digestive tract [7, 8]. Nonspecific symptoms make it difficult to reach a diagnosis and mesenteric hematoma is usually identified by history, abdominal CECT, ultrasound, or magnetic resonance imaging (MRI) [9]. CT scanning is the standard imaging modality which is required to rule out other more common causes of abdominal pain and shock; including abdominal aneurysm, malignancy and acute pancreatitis.
The morning after admission, the patient still had abdominal pain and a decrease in Hb level. Then, a CECT scan was done which showed a large mesenteric hematoma. On subsequent questioning, our patient then recalled the incident of blunt abdominal trauma. He mentioned that the pain was transient and did not remember the incident as significant. This shows the importance of eliciting a detailed history of major or minor trauma for any patients with abdominal pain, as highlighted in other cases too [10].
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. 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 embolized [11]. Recent studies have shown embolization to be successful in the treatment of ruptured aneurysm secondary to pancreatitis and in postoperative bleeding events [12,13].
This case demonstrates a successful non-operative management of a large mesenteric hematoma in a clinically stable patient. Neither CT scan 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 [10]. Regular imaging and clinical follow-up are required to make sure the hematoma is reducing in size and the patient remains well.