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A case of spontaneous mesenteric hematoma with diagnostic difficulty
BACKGROUND: Spontaneous mesenteric hematoma (SMH) is a rare condition characterized by intraperitoneal hemorrhage of unknown etiology. SMH without worsening of general status allows conservative management; however, patients showing chronological changes on imaging require surgical intervention to r...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266863/ https://www.ncbi.nlm.nih.gov/pubmed/32488445 http://dx.doi.org/10.1186/s40792-020-00867-0 |
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author | Tanioka, Nobuhisa Maeda, Hiromichi Tsuda, Sachi Iwabu, Jun Namikawa, Tsutomu Iguchi, Mitsuko Hanazaki, Kazuhiro |
author_facet | Tanioka, Nobuhisa Maeda, Hiromichi Tsuda, Sachi Iwabu, Jun Namikawa, Tsutomu Iguchi, Mitsuko Hanazaki, Kazuhiro |
author_sort | Tanioka, Nobuhisa |
collection | PubMed |
description | BACKGROUND: Spontaneous mesenteric hematoma (SMH) is a rare condition characterized by intraperitoneal hemorrhage of unknown etiology. SMH without worsening of general status allows conservative management; however, patients showing chronological changes on imaging require surgical intervention to rule out possible malignancy. CASE PRESENTATION: A 69-year-old man was referred to our hospital to evaluate an abdominal mass with no associated clinical symptoms. He had a history of chronic hepatitis C and diabetes mellitus. Six months earlier, computed tomography (CT) revealed a 75-mm tumor arising from the jejunum, suspected to be a gastrointestinal stromal tumor (GIST) of the small intestine. Following a further 6 months of observation, the patient was referred to our hospital. Abdominal contrast-enhanced CT revealed a well-defined heterogeneous round tumor with a maximum diameter of 75 mm adjacent to the upper jejunum. The tumor was accompanied by calcification at the periphery, with no evidence of augmentation over the prior 6 months. Diffuse lymphadenopathy was observed around the aorta and splenic artery. Under the diagnosis of GIST arising from small intestine, the patient underwent elective surgery. The resection revealed an elastic soft tumor at the mesentery adjacent to the upper jejunum with severe adhesion between the tumor and jejunum. The tumor origin was unclear; thus, we performed mesenteric excision and partial enterectomy without lymph node dissection. The tumor was surrounded by fibrous capsular tissue containing massive hemosiderin deposits and cholesterol crystals showing partial calcification, resulting in a diagnosis of spontaneous hematoma of the mesentery. CONCLUSIONS: We report a case of SMH mimicking small intestinal GIST. It is difficult to diagnose long-established SMH because its radiological features change with time, and more case reports are needed to improve the accuracy of diagnosis. |
format | Online Article Text |
id | pubmed-7266863 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-72668632020-06-15 A case of spontaneous mesenteric hematoma with diagnostic difficulty Tanioka, Nobuhisa Maeda, Hiromichi Tsuda, Sachi Iwabu, Jun Namikawa, Tsutomu Iguchi, Mitsuko Hanazaki, Kazuhiro Surg Case Rep Case Report BACKGROUND: Spontaneous mesenteric hematoma (SMH) is a rare condition characterized by intraperitoneal hemorrhage of unknown etiology. SMH without worsening of general status allows conservative management; however, patients showing chronological changes on imaging require surgical intervention to rule out possible malignancy. CASE PRESENTATION: A 69-year-old man was referred to our hospital to evaluate an abdominal mass with no associated clinical symptoms. He had a history of chronic hepatitis C and diabetes mellitus. Six months earlier, computed tomography (CT) revealed a 75-mm tumor arising from the jejunum, suspected to be a gastrointestinal stromal tumor (GIST) of the small intestine. Following a further 6 months of observation, the patient was referred to our hospital. Abdominal contrast-enhanced CT revealed a well-defined heterogeneous round tumor with a maximum diameter of 75 mm adjacent to the upper jejunum. The tumor was accompanied by calcification at the periphery, with no evidence of augmentation over the prior 6 months. Diffuse lymphadenopathy was observed around the aorta and splenic artery. Under the diagnosis of GIST arising from small intestine, the patient underwent elective surgery. The resection revealed an elastic soft tumor at the mesentery adjacent to the upper jejunum with severe adhesion between the tumor and jejunum. The tumor origin was unclear; thus, we performed mesenteric excision and partial enterectomy without lymph node dissection. The tumor was surrounded by fibrous capsular tissue containing massive hemosiderin deposits and cholesterol crystals showing partial calcification, resulting in a diagnosis of spontaneous hematoma of the mesentery. CONCLUSIONS: We report a case of SMH mimicking small intestinal GIST. It is difficult to diagnose long-established SMH because its radiological features change with time, and more case reports are needed to improve the accuracy of diagnosis. Springer Berlin Heidelberg 2020-06-01 /pmc/articles/PMC7266863/ /pubmed/32488445 http://dx.doi.org/10.1186/s40792-020-00867-0 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Case Report Tanioka, Nobuhisa Maeda, Hiromichi Tsuda, Sachi Iwabu, Jun Namikawa, Tsutomu Iguchi, Mitsuko Hanazaki, Kazuhiro A case of spontaneous mesenteric hematoma with diagnostic difficulty |
title | A case of spontaneous mesenteric hematoma with diagnostic difficulty |
title_full | A case of spontaneous mesenteric hematoma with diagnostic difficulty |
title_fullStr | A case of spontaneous mesenteric hematoma with diagnostic difficulty |
title_full_unstemmed | A case of spontaneous mesenteric hematoma with diagnostic difficulty |
title_short | A case of spontaneous mesenteric hematoma with diagnostic difficulty |
title_sort | case of spontaneous mesenteric hematoma with diagnostic difficulty |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266863/ https://www.ncbi.nlm.nih.gov/pubmed/32488445 http://dx.doi.org/10.1186/s40792-020-00867-0 |
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