Delayed presentation of intramural cecal hematoma with challenges in the treatment. A case report and review of the literature.
Int J Surg Case Rep 2021;
82:105884. [PMID:
33887649 PMCID:
PMC8086017 DOI:
10.1016/j.ijscr.2021.105884]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/04/2021] [Indexed: 11/18/2022] Open
Abstract
Intramural cecal hematoma is a rare condition with only 14 reported cases.
It can mimic acute appendicitis.
A history of trauma, if present, may offer a pointer to the diagnosis.
Conservative treatment is the first choice in management. However, surgery still has a role.
Evacuation of cecal hematoma can preserve the colon in selected patients.
Introduction
Intramural cecal hematomas are rarely encountered clinical entities with only 14 cases reported in our literature. It is usually reported after blunt external trauma, endoscopy-related trauma, coagulopathies, and occasionally spontaneous. Most cases presented acutely after primary insult; however, a delayed presentation rarely can occur.
Case presentation
Herein we describe an 8-year-old male patient who presented to the emergency department with an appendicitis-like picture six weeks after a history of falling. Intraoperatively, the patient was found to have a normal appendix. However, a large intramural cecal hematoma contains black blood with many clots was found. The patient was treated by hematoma evacuation with preservation of the cecum and colon and he was discharged with uneventful recovery. During two years follow up there was no history of complications or recurrence.
Discussion
Intramural cecal hematoma could be presented with various symptoms that range from mild abdominal pain to severe abdominal pain with vomiting, intestinal obstruction, bowel perforation, and hemoperitoneum. Diagnosis is challenging, and CT scan is the key for diagnosis. Although Conservative therapy is the first-line treatment; however, surgery still has a role in selected cases.
Conclusion
The authors report the first case of cecal hematomas with a delayed presentation. The optimal treatment should be individualized according to different etiologies, the patient's stability, and the presence of complications.
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