Idiopathic spontaneous lesser sac haematoma: a perplexing case of abdominal apoplexy
A 37-year-old woman presented with a 3-hour history of back pain, nausea and vomiting and an episode of syncope. A fluid collection in the lesser sac was detected on ultrasound and CT scan. Emergency laparoscopy and subsequent laparotomy were performed and a large blood clot was evacuated from the l...
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| Veröffentlicht in: | BMJ case reports 2017-08, Vol.2017, p.bcr-2017-220465 |
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| creator | Da Cunha, Nikita Narayanan, Aravindan Marimuthu, Kalimuthu Piramanayagam, Bala |
| description | A 37-year-old woman presented with a 3-hour history of back pain, nausea and vomiting and an episode of syncope. A fluid collection in the lesser sac was detected on ultrasound and CT scan. Emergency laparoscopy and subsequent laparotomy were performed and a large blood clot was evacuated from the lesser sac. No identifiable source or predisposition to bleeding was found. She made a full recovery postoperatively. There are few reported cases of spontaneous intraperitoneal haemorrhage. In a third of cases, there is no identifiable source of bleeding. Unfortunately, patients present late with non-specific symptoms and a prompt diagnosis is difficult to make. The case reiterates the importance of awareness of lesser sac haematoma formation; an unusual clinical entity with a high morbidity and mortality rate. A high index of suspicion, radiological adjuncts and appropriate surgical intervention, especially in unstable patients, is essential for a good outcome. |
| doi_str_mv | 10.1136/bcr-2017-220465 |
| format | Article |
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A fluid collection in the lesser sac was detected on ultrasound and CT scan. Emergency laparoscopy and subsequent laparotomy were performed and a large blood clot was evacuated from the lesser sac. No identifiable source or predisposition to bleeding was found. She made a full recovery postoperatively. There are few reported cases of spontaneous intraperitoneal haemorrhage. In a third of cases, there is no identifiable source of bleeding. Unfortunately, patients present late with non-specific symptoms and a prompt diagnosis is difficult to make. The case reiterates the importance of awareness of lesser sac haematoma formation; an unusual clinical entity with a high morbidity and mortality rate. A high index of suspicion, radiological adjuncts and appropriate surgical intervention, especially in unstable patients, is essential for a good outcome.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2017-220465</identifier><identifier>PMID: 28823999</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Abdomen ; Adult ; Blood platelets ; Case reports ; Diagnosis, Differential ; Female ; Hematoma - surgery ; Hemoperitoneum - diagnostic imaging ; Hemoperitoneum - pathology ; Hemoperitoneum - surgery ; Humans ; Hypertension ; Laparoscopy ; Laparoscopy - methods ; Laparotomy - methods ; Medical imaging ; Mortality ; Pain ; Pancreas ; Patients ; Peritoneal Cavity - blood supply ; Peritoneal Cavity - pathology ; Reminder of Important Clinical Lesson ; Stomach ; Syncope - diagnosis ; Syncope - etiology ; Tomography, X-Ray Computed ; Trauma ; Treatment Outcome ; United Kingdom ; Veins & arteries ; White</subject><ispartof>BMJ case reports, 2017-08, Vol.2017, p.bcr-2017-220465</ispartof><rights>BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</rights><rights>Copyright: 2017 © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</rights><rights>BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b3715-6f21def3a1d59b0fc792f22dec0f72678ad86b7b96bd30b970384de70f6464c83</citedby><cites>FETCH-LOGICAL-b3715-6f21def3a1d59b0fc792f22dec0f72678ad86b7b96bd30b970384de70f6464c83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623252/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623252/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28823999$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Da Cunha, Nikita</creatorcontrib><creatorcontrib>Narayanan, Aravindan</creatorcontrib><creatorcontrib>Marimuthu, Kalimuthu</creatorcontrib><creatorcontrib>Piramanayagam, Bala</creatorcontrib><title>Idiopathic spontaneous lesser sac haematoma: a perplexing case of abdominal apoplexy</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><description>A 37-year-old woman presented with a 3-hour history of back pain, nausea and vomiting and an episode of syncope. A fluid collection in the lesser sac was detected on ultrasound and CT scan. Emergency laparoscopy and subsequent laparotomy were performed and a large blood clot was evacuated from the lesser sac. No identifiable source or predisposition to bleeding was found. She made a full recovery postoperatively. There are few reported cases of spontaneous intraperitoneal haemorrhage. In a third of cases, there is no identifiable source of bleeding. Unfortunately, patients present late with non-specific symptoms and a prompt diagnosis is difficult to make. The case reiterates the importance of awareness of lesser sac haematoma formation; an unusual clinical entity with a high morbidity and mortality rate. A high index of suspicion, radiological adjuncts and appropriate surgical intervention, especially in unstable patients, is essential for a good outcome.</description><subject>Abdomen</subject><subject>Adult</subject><subject>Blood platelets</subject><subject>Case reports</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Hematoma - surgery</subject><subject>Hemoperitoneum - diagnostic imaging</subject><subject>Hemoperitoneum - pathology</subject><subject>Hemoperitoneum - surgery</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Laparotomy - methods</subject><subject>Medical imaging</subject><subject>Mortality</subject><subject>Pain</subject><subject>Pancreas</subject><subject>Patients</subject><subject>Peritoneal Cavity - blood supply</subject><subject>Peritoneal Cavity - pathology</subject><subject>Reminder of Important Clinical Lesson</subject><subject>Stomach</subject><subject>Syncope - diagnosis</subject><subject>Syncope - etiology</subject><subject>Tomography, X-Ray Computed</subject><subject>Trauma</subject><subject>Treatment Outcome</subject><subject>United Kingdom</subject><subject>Veins & arteries</subject><subject>White</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkU1LHTEUhkOxVLGuu5OAGxFG8zGTTLooiGgrCN1Y6C6cfHnnMjOZJnPF--_NZaxYN80mgfPk5ZzzIPSFknNKubgwNlWMUFkxRmrRfEAHVDaykor83nvz3kdHOa9JOZzWbc0_oX3WtowrpQ7Q_a3r4gTzqrM4T3GcYfRxk3Hvc_YJZ7B4BX6AOQ7wFQOefJp6_9SND9hC9jgGDMbFoRuhxzDFXXH7GX0M0Gd_9HIfol831_dXP6q7n99vry7vKsMlbSoRGHU-cKCuUYYEKxULjDlvSZBMyBZcK4w0ShjHiVGS8LZ2XpIgalHblh-ib0vutDGDd9aPc4JeT6kbIG11hE7_Wxm7lX6Ij7oRjLOGlYDTl4AU_2x8nvXQZev7ftmCpooTxUWjVEFP3qHruEll6oUqrTHJC3WxUDbFnJMPr81QonfSdJGmd9L0Iq38OH47wyv_V1EBzhbADOv_pj0D_hSgtw</recordid><startdate>20170818</startdate><enddate>20170818</enddate><creator>Da Cunha, Nikita</creator><creator>Narayanan, Aravindan</creator><creator>Marimuthu, Kalimuthu</creator><creator>Piramanayagam, Bala</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170818</creationdate><title>Idiopathic spontaneous lesser sac haematoma: a perplexing case of abdominal apoplexy</title><author>Da Cunha, Nikita ; 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A fluid collection in the lesser sac was detected on ultrasound and CT scan. Emergency laparoscopy and subsequent laparotomy were performed and a large blood clot was evacuated from the lesser sac. No identifiable source or predisposition to bleeding was found. She made a full recovery postoperatively. There are few reported cases of spontaneous intraperitoneal haemorrhage. In a third of cases, there is no identifiable source of bleeding. Unfortunately, patients present late with non-specific symptoms and a prompt diagnosis is difficult to make. The case reiterates the importance of awareness of lesser sac haematoma formation; an unusual clinical entity with a high morbidity and mortality rate. A high index of suspicion, radiological adjuncts and appropriate surgical intervention, especially in unstable patients, is essential for a good outcome.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>28823999</pmid><doi>10.1136/bcr-2017-220465</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Abdomen Adult Blood platelets Case reports Diagnosis, Differential Female Hematoma - surgery Hemoperitoneum - diagnostic imaging Hemoperitoneum - pathology Hemoperitoneum - surgery Humans Hypertension Laparoscopy Laparoscopy - methods Laparotomy - methods Medical imaging Mortality Pain Pancreas Patients Peritoneal Cavity - blood supply Peritoneal Cavity - pathology Reminder of Important Clinical Lesson Stomach Syncope - diagnosis Syncope - etiology Tomography, X-Ray Computed Trauma Treatment Outcome United Kingdom Veins & arteries White |
| title | Idiopathic spontaneous lesser sac haematoma: a perplexing case of abdominal apoplexy |
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