Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018:44:33-37.
doi: 10.1016/j.ijscr.2018.02.008. Epub 2018 Feb 10.

Spontaneous mesenteric hematoma of the sigmoid colon associated with rivaroxaban: A case report

Katsuhisa Hirano  1 , Tadashi Bando  2 , Soshi Osawa  3 , Tetsuro Shimizu  4 , Tomoyuki Okumura  5 , Tsutomu Fujii  6
Affiliations

Spontaneous mesenteric hematoma of the sigmoid colon associated with rivaroxaban: A case report

Katsuhisa Hirano et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Mesenteric hematoma is a rare condition caused by bleeding localized in the mesenteric vascular tree. This is a first report of spontaneous mesenteric hematoma caused by rivaroxaban.

Presentation of case: The patient was a 71-year-old man who had taken rivaroxaban for paroxysmal atrial fibrillation. He had experienced abdominal pain and diarrhea for the prior 3 days. He had little melena and was referred to our institute. He presented with hypotension on arrival. Computed tomography (CT) revealed a 10 cm mass in the mesentery of the sigmoid colon with extravasation. Active bleeding from the sigmoid colic arteries was embolized with angiography on the day of admission. On the second day, we operated on the patient. We detected 200 mL of bloody ascites accumulated in the abdomen. The serosa of the sigmoid colon was ruptured along the tenia due to the compression of the hematoma in the mesentery. The sigmoid colon was resected and a descending colostomy was reconstructed. Operative and pathological findings did not reveal the cause of bleeding. We finally diagnosed the patient with spontaneous mesenteric hematoma associated with rivaroxaban.

Discussion: Previous reports of mesenteric hematoma with anticoagulant were associated with warfarin. Since rivaroxaban is not affect to the value of prothrombin time (PT) and activated partial thromboplastin time (APTT) and mesenteric hematoma presents non-specific symptoms, it is difficult to diagnose mesenteric hematoma in the patients taking rivaroxaban.

Conclusion: It is important to keep in mind that mesenteric hematoma is one of the critical complications in patients taking rivaroxaban.

Keywords: Anticoagulation; Mesenteric hematoma; Rivaroxaban; Sigmoid colon.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Computed tomography findings. Computed tomography revealed a low-density mass close to the sigmoid colon, with a 10 cm diameter, and ascites accumulated around the spleen. Small extravasations were confirmed in the mass (arrows).
Fig. 2
Fig. 2
Interventional radiography findings. Angiography from the inferior mesenteric artery revealed small extravasations in the region of the sigmoid colic arteries (arrows). The sigmoid colic arteries were embolized while preserving the left colic artery and superior rectal artery and the extravasations disappeared (b).
Fig. 3
Fig. 3
Intraoperative findings and specimens. During surgery, 200 mL of bloody ascites were found to be accumulated in the abdomen. The serosa of the sigmoid colon was ruptured without active bleeding (a). The hematoma was localized in the mesentery of the sigmoid colon and the anterior serosa was ruptured due to the compression of the hematoma (b, c).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kubota T., Mizokami K., Shimaguchi M., Katagiri H., Okumura K., Yoshikawa K., Sakamoto T. A occult transverse laceration with only mesenteric hematoma: no free air, no ascitic fluid, no bowel thickening in CT do not give us a guarantee in which surgically important bowel injury is absent. HSOA J. Emerg. Med. Trauma Surg. Care. 2016;3:015.
    1. Kappikeri V.S., Akshay K., Vinayak I. Haematoma in the mesentery of terminal ileum and intramural haematoma of caecum, ascending colon with hemoperitoneum due to abdominal massage. RGUHS Med. Sci. 2017;7:38–39.
    1. Shikata D., Nakagomi H., Takano A., Nakagomi T., Watanabe H., Maruyama M., Nakada H., Yamamoto A., Furuya K., Hada M., Miyasaka Y., Omata M., Oyama T. Report of a case with a spontaneous mesenteric hematoma that ruptured into the small intestine. Int. J. Surg. Case Rep. 2016;24:124–127. - PMC - PubMed
    1. Chaiteerakij R., Treeprasertsuk S., Mahachai V., Kullavanijaya P. Anticoagulant-induced intramural intestinal hematoma: report of three cases and literature review. J. Med. Assoc. Thail. 2008;91:1285–1290. - PubMed
    1. Bekheit M., AlaaSallam M., Khafagy P.A., Corder R., Katri K. Non-traumatic intramural hematomas in patients on anticoagulant therapy: report of three cases and overview of the literature. Afr. J. Emerg. Med. 2014;4:e1–e4.