Idiopathic spontaneous intramural hematoma of the colon: a case report and review of the literature

Abstract

An 82-year-old man visited our hospital for abdominal discomfort and constipation lasting 3 days. He did not have a history of trauma or bleeding tendency. His laboratory studies showed slight anemia and inflammatory reactions, but other data including coagulation profiles were all normal. Computed tomography (CT) demonstrated a 6-cm high-density mass in the left upper quadrant and slight ascites. Contrast-enhanced CT revealed that the lesion was not enhanced. Colonoscopy could not detect the lesion. Laparotomy was performed because malignancy could not be ruled out. The mass was located in the transverse colon, and histologic examination showed intramural hematoma. Neither arteriovenous malformation nor a foreign body such as a fish bone was identified, indicating that the mass was considered to be idiopathic intramural colonic hematoma. We present this rare case and also a review of the literature.

Traumatic Acute Colonic Intramural Hematoma: A Rare Entity and Successful Expectant Approach

“…Hughes et al reported about 109 cases of post-traumatic acute intramural hematoma in 1977, in which only 4% of cases were colonic intramural hematoma [4]. Since 1950, there were 16 cases with traumatic colonic intramural hematoma, which was more common in ascending colon [5,6]. Cases were reported to be managed by both conservative and surgical methods.…”

“…The bowel regions, which were at the junction between retroperitoneally fixed and not fixed, were most commonly affected. The most commonly involved region of bowel with traumatic acute intramural hematoma was duodenum, followed by ascending colon/caecum [5,6].…”

“…Intramural hematoma can lead to acute and chronic complications. The acute complications are severe hemodynamic compromise due to blood loss by free rupture of hematoma into the peritoneum, gangrene of the involved bowel, intestinal obstruction, and intussusception [6]. The late complication is chronic stenotic lesion causing obstruction due to fibrosis.…”

Colonic Perforation Secondary to Idiopathic Intramural Hemorrhage

“…One report has been published on a patient with a transverse colonic intramural hematoma that was managed nonoperatively; the patient was undergoing antiplatelet therapy [5]. An idiopathic hematoma in the transverse colon without a history of trauma or anticoagulants that was managed nonoperatively was reported by Umeda et al [4], and an idiopathic hematoma in the transverse colon that was managed surgically was reported by Nozu [6]. However, to the best of our knowledge, no reports of idiopathic intramural hematomas of the colon with perforation have been published.…”

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

“…Other risk factors are hemophilia [3], leukemia, lymphoma, chemotherapy, idiopathic thrombocytopenic purpura [4]. Spontaneous idiopathic occurrence is, on the contrary, very rare and involvement of the colon is exceptional with only sporadic cases reported in the Literature [5,6].…”