DISCUSSSION
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.