Atypical presentation of catastophric spontaneous mesenteric bleeding.
May Honey OhnJun Rong NgNg Pey LuenKhin Maung OhnPublished in: BMJ case reports (2021)
Spontaneous mesenteric bleeding is an exceptionally rare clinical condition and potentially lethal especially among elderly patients who are taking oral anticoagulant. We present a case of a 79-year-old woman who presented to the emergency department with atypical chest pain which was radiating to the back. She developed profound hypotension with a sudden drop of haemoglobin. Contrast-enhanced CT of the aorta showed active mesenteric bleeding with mesenteric haematoma. The early diagnosis relies solely on a high index of suspicion of occult bleeding in patients with unexplained hypotension with a sudden drop of haemoglobin. Troponin can be falsely positive in mesenteric bleeding. Close monitoring to detect any sign of deterioration and early imaging in diagnosing intra-abdominal bleeding can help to avoid delay in treatment which is essential to prevent mortality and morbidity.
Keyphrases
- atrial fibrillation
- contrast enhanced
- emergency department
- computed tomography
- magnetic resonance imaging
- magnetic resonance
- high resolution
- dual energy
- case report
- type diabetes
- risk factors
- coronary artery disease
- mass spectrometry
- pulmonary artery
- image quality
- photodynamic therapy
- smoking cessation
- aortic dissection
- fluorescence imaging