Spontaneous mesenteric hematoma of the sigmoid colon associated with rivaroxaban: A case report
| Autor: | Tadashi Bando, Tsutomu Fujii, Tetsuro Shimizu, Tomoyuki Okumura, Soshi Osawa, Katsuhisa Hirano |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Abdominal pain medicine.medical_treatment SRA superior rectal artery 030204 cardiovascular system & hematology Article Anticoagulation 03 medical and health sciences 0302 clinical medicine Hematoma Rivaroxaban Melena PT prothrombin time medicine cardiovascular diseases Mesenteric hematoma Sigmoid colon Mesentery APTT activated partial thromboplastin time DOAC direct oral anticoagulant business.industry Colostomy pathological conditions signs and symptoms LCA left colic artery medicine.disease CT computed tomography Surgery body regions surgical procedures operative medicine.anatomical_structure cardiovascular system Abdomen 030211 gastroenterology & hepatology IVR interventional radiography PT-INR prothrombin time-international normalized ratio medicine.symptom business medicine.drug |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2018.02.008 |
| Popis: | Highlights • Mesenteric hematoma is a rare condition without specific symptoms. • Rivaroxaban is not affect to the value of PT or APTT. • It is difficult to diagnose mesenteric hematoma. 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. |
| Databáze: | OpenAIRE |
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