Abstract
A 3-year-old boy was referred to our hospital because of prolonged abdominal pain and bile-stained vomit. CT, MRI and ultrasonographic examination demonstrated a huge cystic mass in the left upper abdominal quadrant. The cystic mass was strongly suspected to be a mesenteric cyst, and laparotomy was undertaken. However, the laparotomy revealed that the mass was organized as a huge intramural hematoma of the jejunum (16.5cm×6.3cm×5.0cm), which was successfully resected. Children with an intramural hematoma of the intestine resulting from blunt and sometimes vague trauma do not present in a clear manner. It is hard to distinguish a hematoma with hydropic degeneration from a mesenteric cyst even with CT, MRI and ultrasonographic examination. The vast majority of reported cases in which an operation has been performed required only evacuation of the hematoma through a serosal incision. But in cases whose hematoma is organized, resection of the involved portion should be employed, because incomplete evacuation may invite delayed stenosis of the intestine. This prompted us to question routine nonoperative management and think that operative intervention may be more appropriate in some instances, particularly when lengthy periods of supportive treatment would be necessary.
