Delayed presentation of intramural cecal hematoma with challenges in the treatment. A case report and review of the literature

Abstract

Highlights Intramural cecal hematoma is a rare condition with only 14 reported cases. It can mimic acute appendicitis. A history of trauma, if present, may offer a pointer to the diagnosis. Conservative treatment is the first choice in management. However, surgery still has a role. Evacuation of cecal hematoma can preserve the colon in selected patients.

Colonic Intramural Hematoma in a Cat: A Case Report

“…Surgical evacuation of the hematoma by laparotomy is more feasible, because it can facilitate a direct approach of the lesion and ensure there is no oozing after evacuation. Complications of surgical evacuation include hemoperitoneum, peritonitis, and intestinal perforation (18). In our case, ultrasonography revealed the location of the mass was between the submucosal and muscular layers, and the thickness of the mass was more than 1.3 cm, thus we considered incision from the mucosal surface for surgical evacuation was safe.…”

“…In the veterinary literature for dogs and horses, small intestinal intramural hematomas are usually noted within the tunica muscularis or between the submucosa and tunica muscularis; whereas large intestinal intramural hematomas in houses are usually located in the submucosa (6,8,(12)(13)(14). The intestinal mucosa contains numerous blood and lymph vessels, and hematomas are produced at the tunica muscularis and submucosal layer upon tearing of the terminal artery vessels as they leave the mesentery to penetrate the muscular layer of the intestinal wall, which may explain why the colonic intramural hematoma in this cat was located between the submucosa and muscular layer on ultrasonographic images (15)(16)(17)(18). However, in our case, only the mucosa and submucosa could be pathologically evaluated because an invasive procedure for full-thickness intestinal biopsy was not performed at the owner's request.…”

“…Surgical intervention includes surgical excision and surgical evacuation. Surgical excision, such as in hemicolectomy, is often required in cases showing failure of conservative treatment, peritonitis, hemoperitoneum, and intractable bleeding; whereas surgical evacuation may be considered in cases without mucosal perforation (18). Evacuation solely by colonoscopy is rarely seen in the literature because it is difficult to detect and sample colonic intramural hematoma in deeper layers, such as the muscular layer (6,35).…”

Surgical treatment of colonic intramural haematoma secondary to penetrating trauma

“…Our report is the first to describe a colonic intramural haematoma due to penetrating trauma. Our report is also the third to describe surgical evacuation and repair rather than colonic resection 1,2 …”

“…Our report is also the third to describe surgical evacuation and repair rather than colonic resection. 1,2 Intramural haematomas are caused by bleeding from terminal arteries penetrating the bowel wall, dissecting bowel wall layers. 3 An intramural haematoma can occur anywhere along the gastrointestinal tract.…”