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Atypical presentation of catastophric spontaneous mesenteric bleeding
  1. May Honey Ohn1,
  2. Jun Rong Ng2,
  3. Ng Pey Luen3 and
  4. Khin Maung Ohn4
  1. 1Cardiology department, Lewisham Hospital NHS Trust, London, UK
  2. 2Faculty of medicine and health sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  3. 3Emergency department, Miri Hospital, Miri, Sarawak, Malaysia
  4. 4Surgery department, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
  1. Correspondence to Dr May Honey Ohn; mayhoney.ohn{at}gmail.com

Abstract

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.

  • cardiovascular system
  • resuscitation
  • unwanted effects / adverse reactions
  • vascular surgery

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Footnotes

  • Contributors MHO involves in the management of the patient and revised the article. She wrote the initial draft of the article. JRN and NPL performed the literature search and wrote the final draft of the article and case description. KMO has provided the appropriate guidance to write and publish the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.