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Surgery: Case Report

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Management of inadvertent mesenteric hematoma during total radical colectomy

Author(s): Hitesh J Chavda* and Bhavik C Vasoya

BACKGROUND: Any inadvertent bleeding during surgery is difficult to manage despite of availability of many hemostatic instruments like diathermy, ligasure, harmonic scalpel and other vessel sealing devices. Usually it is difficult to identify and control the actively bleeding artery at the route of the mesentery causing expanding hematoma and hemodynamic instability. Angioembolization is a better option over surgical exploration of hematoma in such situations. CASE PRESENTATION: A 76-year-old gentleman had carcinoma of rectum with synchronous growth in ascending and descending colon. He underwent total radical colectomy. Inadvertent bleeding from the middle colic artery causing expanding hematoma at root of mesentery was controlled with angioembolisation. DISCUSSION: Most of the mesenteric hematoma does not require any intervention. Active bleeding with hemodynamic instability warrants urgent intervention like angioembolisation or surgery. CONCLUSION: Exploration of mesenteric hematoma to control the bleeding artery is technically very difficult due to hypotension and hemodynamic instability. Urgent angioembolization to locate and control the bleeding is the safer and better option in such conditions.

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