Spontaneous perforation of an intramural rectal hematoma: report of a case

Abstract

Spontaneous hematomas are rare and most occur secondary to hematologic disorders or during anticoagulant therapy. Most spontaneous hematomas occur above the sigmoid colon, and rarely in the rectum. Herein we present the case of a patient with a spontaneous perforating hematoma of the rectum who presented with severe abdominal pain after a bloody stool. The hemoglobin level decreased by 33 g/L within 20 h. An abdominal sonogram showed a hydrops in the lower abdomen with a maximum depth of 7.0 cm. A hematoma, 8 cm × 6 cm × 5 cm in size, was noted intra-operatively in the rectosigmoid junction, with a 1.5-cm perforation in the hematoma and active hemorrhage. Thus, a partial rectectomy and sigmoidostomy were performed. Three months later, a second operative procedure to re-establish intestinal continuity was performed. The patient is in good condition 12 mo after the last surgery. In addition to this case, the causes of spontaneous perforating hematomas and the treatment are discussed.

Keywords: Complications; Diagnosis; Hematoma; Prothrombin time; Rectum; Therapy.

Figure 1

Pre-operative photograph of the perineum (knee-chest position) revealing widespread perianal ecchymosis (marked with black arrows).

Figure 2

Intra-operative photograph of a large intramural hematoma arising beneath the rectosigmoid junction.

Figure 3

Extensive oozing of blood in the muscular layer of the resected rectal and fibrinoid necrosis within the vascular wall (hematoxylin and eosion stain, × 20).