Abstract
A 66-year-old woman visited our hospital because of right flank pain. Computed tomography (CT) revealed a cystic mass with some enhanced areas, located between the liver and ascending colon. As she had multiple liver cysts, the mass was suspected to be one of the liver cysts, with intracystic hemorrhage. Several days later, repeated CT revealed that the cystic mass had become smaller and closer to the ascending colon. The CT also revealed thickening of the wall of the transverse colon. Colonoscopy was performed, thereby an advanced cancer of the transverse colon was found. Right hemicolectomy was performed. The specimen showed a type 4 tumor, 33×30 mm in diameter, SE with depth of invasion, mainly with poorly differentiated adenocarcinoma. The cystic mass was revealed as to be an intramural hematoma, 35 mm in diameter, located from the subserosal space to the submucosal layer of the ascending colon. Cancer cells were also found in the subserosal space of the hematoma. The transverse colon cancer implanted to the ascending colon and thus might cause hemorrhage in the intramural space of the colon. Intramural hematoma of the colon is rare and mostly caused by trauma or bleeding. We report an extremely uncommon case of intramural hematoma associated with colon cancer.
