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
. 2019:60:16-20.
doi: 10.1016/j.ijscr.2019.05.004. Epub 2019 May 9.

Idiopathic intramural hematoma of the right colon. A case report and review of the literature

Rosario Vecchio  1 , Emma Cacciola  2 , Michele Figuera  3 , Renato Catalano  1 , Giuseppe Giulla  1 , Emanuele Rosario Distefano  1 , Eva Intagliata  4
Affiliations

Idiopathic intramural hematoma of the right colon. A case report and review of the literature

Rosario Vecchio et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Intestinal hematoma is usually observed after an abdominal trauma or in patients treated with anticoagulant therapy. Conversely, idiopathic bowel hematoma is very rare, being colon involvement sporadic with few reports in the Literature.

Presentation of case: The Authors report a case of idiopathic spontaneous large bowel hematoma. A 48-year-old man was admitted for a thoraco-abdominal pain and signs of acute abdomen and fever. After ruling out heart diseases, a CT scan revealed a marked thickening of the ascending colon wall, obstructing the bowel lumen. Leukocytosis was observed. In an emergency setting, an explorative laparotomy was performed. Hemoperitoneum and a large hematoma involving the caecum and the ascending colon were detected, together with intramesenteric and retroperitoneal blood effusion. A right hemicolectomy was accomplished. Histopathology confirmed the diagnosis of large bowel hematoma. Post-operative molecular diagnostic testing for coagulative disorders failed to demonstrate any genetic variation associate with hemorrhagic predisposition. In the post-operative course, the patient experienced a left basal bronco-pneumonia with increased unilateral pleural effusion, successfully treated by a thoracic drain and antibiotic therapy.

Discussion: The reported case and Literature data show that diagnosis of idiopathic colon intramural hematoma is challenging, especially in the emergency setting. Although conservative therapy is the first line treatment, surgery still has an important role when the diagnosis is uncertain, medical treatment fails or a complication, such untreatable bleeding, perforation or occlusion occur.

Conclusion: The Authors report a very rare case of spontaneous intramural hematoma of the right colon. Surgery still has a role in selected cases.

Keywords: Case report; Intestinal hematoma; Intestinal obstruction; Large bowel hematoma; Mesenteric hemorrhagic effusion.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
(a) CT scan revealing marked thickening of right colon. (b) Pleural effusion with pulmonary atelectasia.
Fig. 2
Fig. 2
Surgical specimen showing massive intramural hematoma of the right colon.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Yin W.Y., Gueng M.K., Huang S.M., Chen H.T., Chang T.M. Acute colonic intramural hematoma due to blunt abdominal trauma. Int. Surg. 2000;85(January-March (1)):51–54. - PubMed
    1. Zhou H., Wang S., Zhu L. Submucosal hematoma of the sigmoid colon as a complication of anticoagulation treatment. J. Gastrointest. Surg. 2018;22(November (11)):1995–1997. - PubMed
    1. Nakayama Y., Fukushima M., Sakai M., Hisano T., Nagata N., Shirahata A., Itoh H. Intramural hematoma of the cecum as the lead point of intussusception in an elderly patient with hemophilia A: report of a case. Surg. Today. 2006;36(6):563–565. - PubMed
    1. Abbas M.A., Collins J.M., Olden K.W., Kelly K.A. Spontaneous intramural small-bowel hematoma: clinical presentation and long-term outcome. Arch. Surg. 2002;137(March (3)):306–310. - PubMed
    1. De Santis G., Sista F., Giuliani A., Leardi S. Idiopathic intramural hematoma of sigmoid colon. A case report. Ann. Ital. Chir. 2011;82(September-October (5)):395–397. - PubMed