PMC6389503_01
Abdominal contrast-enhanced computed tomography (CT) findings.. (a) A mass (white arrow) with coexisting low- and high-density areas with a maximum diameter of 120 mm adjacent to the stomach (yellow arrow).. (b) A mass (white arrow) adjacent to the transverse colon (yellow arrow).. (c) Extravasation (white arrow) in the mass was observed in the arterial phase.. (d) Extravasation (white arrow) spread in the portal phase.
gr1.jpg
PMC6389503_01_gr1.jpg
fig0005
The abdominal contrast-enhance CT indicated a mass with coexisting low- and high-density areas with a maximum diameter of 120 mm adjacent to the stomach and transverse colon (Fig. 1a,b). An extravasation was observed in the mass in the arterial phase, and it spread in the portal phase (Fig. 1c,d).
Abdominal contrast-enhanced computed tomography (CT) findings.. An air-filled mass (white arrow) measuring 90 mm in diameter.
gr2.jpg
PMC6389503_01_gr2.jpg
fig0010
On the abdominal contrast-enhanced CT, an air-filled mass measuring 90 mm in diameter was observed (Fig. 2).
Colonoscopic findings.. (a) Many ulcers (black arrow) were confirmed at the transverse colon at the splenic flexure.. (b) A fistula (black arrow) with the blood flowing out at the transverse colon at the splenic flexure.
gr3.jpg
PMC6389503_01_gr3.jpg
fig0015
The colonoscopic findings revealed many ulcers and fistulae with the blood flowing out at the transverse colon at the splenic flexure (Fig. 3a,b).
Intraoperative findings.. (a) The mass (white arrow) was confirmed in the mesentery of the transverse colon at the splenic flexure; adhesion developed between the stomach (black arrow), pancreas (black arrowhead), and omentum because of high inflammation.. (b) Released adhesion of the stomach (black arrow) and hematoma (white arrow) while touching the hematoma.
gr4.jpg
PMC6389503_01_gr4.jpg
fig0020
We changed the procedure to hand-assisted laparoscopic surgery (HALS) to perform the operation safely (Fig. 4a,b).
Macroscopic pathological findings.. The fistula (black arrow) was found between the transverse colon and the mesentery.
gr5.jpg
PMC6389503_01_gr5.jpg
fig0025
Macroscopically, the fistula was found between the transverse colon and mesenteric hematoma (Fig. 5).
Histopathological findings.. (a) The aperture of the fistula. There were no epithelial cells in the fistula (black arrow). (Hematoxylin-eosin stain, original magnification x50).. (b, c) Hematoma component (black arrow) and numerous lymphocytes (black arrowhead) were found in the mesenteric cavity. There were no findings of mesenteric aneurysm and arterial sclerotic change. We diagnosed that a hematoma and an abscess coexisted within the mesenteric cavity. (b. Hematoxylin-eosin stain, original magnification x100; c. Hematoxylin-eosin stain, original magnification x400).
gr6.jpg
PMC6389503_01_gr6.jpg
fig0030
The bottom of the ulcer was connected to the mesentery by an abscess cavity (Fig. 6a-c).