Abdominal Apoplexy: A Case Study of Idiopathic Spontaneous Lesser Sac Hematoma

Abstract

Idiopathic spontaneous intraperitoneal hemorrhage (ISIH) is a rare event associated with high mortality. There have been multiple case reports of spontaneous rupture of middle colic pseudoaneurysms in the literature. Herein, we present a case of a 51-year-old female that presented with spontaneous rupture of the middle colic artery and associated massive intraabdominal hematoma without findings of a pseudoaneurysm. The patient underwent a computed tomography (CT) scan as an outpatient 24 hours prior to the onset of the bleeding due to abdominal pain without findings of hematoma or aneurysm of the mesenteric vessels. Subsequently, the patient underwent emergent exploratory laparotomy with findings of a massive hematoma in the lesser sac and spontaneous bleeding from the middle colic artery that was ligated. The patient had an uneventful postoperative course and fully recovered. To our knowledge, this is the second reported case of idiopathic bleeding from the middle colic artery without evidence of a pseudoaneurysm based on a current review of the literature.

Abdominal apoplexy: A rare case of spontaneous middle colic artery rupture with transverse colectomy

“…It is no surprise then that only 36 reports are available in the literature about abdominal apoplexy from middle colic artery rupture [ 5 , 11 ]. Only two of these are similar to ours in that aneurysmal pathology was not identified [ 2 , 12 ].…”

“…ISIH refers to spontaneous, non-traumatic abdominal bleed due to the rupture of small mesenteric arteries or veins without any evidence of the well-documented etiologies such as pregnancy, malignancy, vasculitis or any other inflammatory processes e.g. pancreatitis [ 2 ]. Although very rare, this entity should be in the differential diagnosis when an otherwise healthy patient presents to the Emergency Department (ED) with an atypical abdominal pain and associated gastrointestinal symptoms, combined with signs of hemodynamic instability and shock [ 3 ].…”

Idiopathic Spontaneous Intraperitoneal Hemorrhage Due to Vascular Malformations in the Muscularis of the Stomach: A Case Report

“…VMs are diseases with unpredictable clinical evolution and manifestations, which lead to life-threatening conditions in severe cases (12). The splenic artery is the most common vessel responsible for ISIH, while the gastric or gastroepiploic artery accounts for only 4% (13). The VMs of the gastric wall generally occur in the gastric mucosa and submucosa, so it usually causes intragastric hemorrhage (14)(15)(16).…”

Idiopathic spontaneous lesser sac haemorrhage possibly due to endometrioma

“…Spontaneous intraperitoneal haemorrhage arises from a non‐traumatic and non‐iatrogenic cause. The majority of cases of spontaneous intraperitoneal haemorrhage result from causes such as malignancy, ectopic pregnancy, inflammatory processes such as pancreatitis, vasculitis, aneurysmal rupture or coagulopathies 1–4 . In a small number of cases, the cause of haemorrhage is not identifiable, and is termed as idiopathic spontaneous intraperitoneal haemorrhage or abdominal apoplexy.…”

“…The majority of cases of spontaneous intraperitoneal haemorrhage result from causes such as malignancy, ectopic pregnancy, inflammatory processes such as pancreatitis, vasculitis, aneurysmal rupture or coagulopathies. [1][2][3][4] In a small number of cases, the cause of haemorrhage is not identifiable, and is termed as idiopathic spontaneous intraperitoneal haemorrhage or abdominal apoplexy. Computed tomography in an acute setting allows differentiation between low-attenuation fluid and blood, which has a higher attenuation.…”