78-year-old male patient with a history of alcoholism for 10 years.
He was admitted to the Emergency Unit of the Care Complex Luco (CABL) with a history of one week of evolution, characterized by pain in the thigh and right hip, progressive in intensity.
The day of hospital admission was associated with abdominal pain in the ipsilateral lower quadrant and an episode of lipothymia.
She had no history of abdominal trauma or other associated diseases.
On physical examination at admission, the patient had a blood pressure of 80/54 mmHg, pulse of 78 x', malaise of the infraumbilical area of the abdominal wall and lower extremities.
1,000 ce of intravenous crystalloid solution were then provided, which allowed normalization of blood pressure.
The abdomen appearedtended, with severe pain due to superficial and deep palpation of the hypochondrium, flank and right iliac fossa.
He also presented diffuse rebound pain, diffuse muscle resistance and positive right percussion wrist.
Laboratory tests at admission showed: 250 mg/dl glycemyl, 17 mg/dl urea nitrogen, 1.17 mg/dl creatinine, 1.17 mg/dl platelet count, amylase 86 39% U/1, reactive lipase 40 U
A contrast-enhanced computed tomography (CT) of the abdomen and pelvis showed a spontaneously hyperdense mass in the hypochondrium and right flank of 16 per 12 per 9 cm in the right colon.
The presence of an extensive mesenteric hematoma could be suggested, but an underlying neoplasm could also be ruled out.
On the second day of hospitalization, the patient was hemodynamically stable, afflicted and with less abdominal pain; however, hematocrit decreased to 21%, surgically controlled when transfusing 2 U red blood cells and intervening
Exploratory laparotomy revealed a large encapsulated right retrope-ritoneal hematoma extending from the transverse mesocolon to the pelvis, without observing an injury with active bleeding.
Was performed drainage, sibling, installation of drainage in the retroperitoneum-neo and taking samples for biopsy, which later was reported as mesenteric hematoma without evidence of neoplasia.
The patient recovered satisfactorily until the sixth postoperative day, when fecal output was observed through drainages, and a diagnosis of stercoraceous fistula was made.
It was then decided to connect the tubular to the dissection and start antibiotic treatment with metronidazole plus ciprofloxacin, resulting in optimal surgical wound management, fistula control d general aspiration and final closure at 20 days.
The patient has been under outpatient follow-up in a surgery polyclinic, asymptomatic at 6 months of follow-up.
