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Idiopathic spontaneous lesser sac haematoma: a perplexing case of abdominal apoplexy
  1. Nikita Da Cunha,
  2. Aravindan Narayanan,
  3. Kalimuthu Marimuthu,
  4. Bala Piramanayagam
  1. Department of Surgery, George Eliot Hospital, Nuneaton, UK
  1. Correspondence to Dr Nikita Da Cunha, nikitadacunha{at}


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.

  • gastrointestinal surgery
  • general surgery

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  • Contributors NDC undertook the literature review and edited the case report. AN and KM were involved in the patient care. AN wrote the initial case report, which was revised by KM and BP.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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