A Case of Spontaneous Mesenteric Hematoma

By Andrew Yocum, MD & Andrew King, MD   A 69-year-old woman with a past medical history of multiple sclerosis, hypertension, hyperlipidemia, remote cerebral vascular accident, and a known abdominal aortic aneurysm was brought to the emergency department by EMS complaining of abdominal pain. Her AA was stable on imaging four months prior to presentation with a measurement of 3.8 cm.   The patient had intermittent generalized abdominal pain over the previous four weeks that resolved without intervention. This episode began almost 24 hours prior to presentation after the patient finished eating. She had a constant, generalized abdominal pain since that time. The patient said the pain was worst in the left lower quadrant. She described the pain as 8/10, sharp, and nonradiating with associated anorexia. She denied any nausea, vomiting, changes in bowel movements, hematochezia, melena, fevers, or chills. She also denies any urinary frequency, dysuria, or hematuria, but does intermittently self-catheterize because of her multiple sclerosis.   The patient’s primary physician prescribed her a course of steroids and Levofloxacin eight days prior to presentation for a cough, which resolved her symptoms.   The patient had a colonoscopy in 2009 that revealed a 4 mm sessile polyp, which was resected and found to be tubular adenoma. She was noted to have a tortuous sigmoid colon at that time.   The patient was normotensive but pale in the ED. Her abdominal exam revealed...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research