A case of spontaneous mesenteric hematoma with diagnostic difficulty

Area of Science:

• Gastroenterology
• Surgical Oncology
• Radiology

Background:

• Spontaneous mesenteric hematoma (SMH) is a rare intraperitoneal hemorrhage of unknown cause.
• Conservative management is suitable for SMH without worsening general status.
• Surgical intervention is indicated for SMH with chronological imaging changes to exclude malignancy.

Purpose of the Study:

• To report a case of SMH mimicking a small intestinal GIST.
• To highlight diagnostic challenges associated with SMH.

Main Methods:

• A 69-year-old male patient with a history of chronic hepatitis C and diabetes mellitus presented with an asymptomatic abdominal mass.
• Initial CT scan revealed a 75-mm jejunal tumor suspected to be GIST.
• Follow-up CT showed a stable, well-defined mass adjacent to the jejunum with peripheral calcification and lymphadenopathy.
• Surgical resection revealed a mesenteric tumor with hemosiderin and cholesterol crystals, leading to a diagnosis of SMH.

Main Results:

• The patient underwent mesenteric excision and partial enterectomy.
• Histopathological examination confirmed SMH, not GIST.
• The tumor exhibited calcification, hemosiderin deposits, and cholesterol crystals.

Conclusions:

• SMH can radiologically mimic small intestinal GIST.
• Diagnosing long-established SMH is difficult due to changing radiological features.
• Additional case reports are necessary to enhance diagnostic accuracy for SMH.