A CASE OF MESENTERIC HEMORRHAGE WITH LATE-ONSET HEMATOMA FOLLOWING ENDOSCOPIC REDUCTION OF SIGMOID VOLVULUS

Abstract

An 82-year-old man was diagnosed as having persistent sigmoid volvulus, which was treated by repeated endoscopic reduction at the referring hospital. However, achieving complete reduction was somewhat difficult. The patient was referred to our hospital, where we could only perform gas reduction endoscopically, which alleviated his symptoms. Five days after the treatment, the patient developed abdominal distension and lower abdominal pain. Abdominal computed tomography showed edema-like wall thickening in the recto-sigmoid area and a high-density space-occupying lesion similar to a hematoma. Emergent surgery was performed due to the intestinal hematoma and the possibility of necrosis. The operative findings revealed recto-sigmoid mesenteric hemorrhage with an approximately 1,000-g hematoma but without bowel necrosis that was treated with Hartmann’s procedure. Histopathological examination of the resected specimen revealed extensive hemorrhage in the mesentery, but neither vascular occlusion nor thromboembolism was observed. We describe details of endoscopic findings and the clinical course of a rare case of recto-sigmoid mesenteric hemorrhage with late-onset hematoma after endoscopic reduction of sigmoid volvulus.