Abstract
An 84-year-old man, who had taken aspirin for cerebral infarction, visited our hospital with abdominal pain. His abdomen was hard and board-like. Computed tomography showed a low dense inhomogeneous mass, ascites, and free air in the pelvic cavity. Emergency laparotomy revealed a subserous hematoma, elastic soft mass, and pus in the sigmoid colon, indicating a perforation of the intestine. Partial resection of the sigmoid colon was performed. Macroscopic findings of the resected specimen showed a submucosal tumor 3 cm in diameter with small central erosion. Histological examination disclosed a mucosal defect, a hematoma within the inner muscular layer, and disruption of the wall structure. The perforation was considered to have taken place due to the disruption of the intestinal wall by mechanical compression from the hematoma caused by coagulopathy with aspirin. There have been 15 reports of idiopathic intramural hematoma of the colorectum in Japanese literature, however, this case is the first associated with perforation. Generally, idiopathic hematoma of the intestine is treated conservatively; however, further examination may be required to detect possible perforation.
