An 81-year-old male was admitted on December 13, 2020 due to upper abdominal pain for 20 h. His medical history revealed hypertension for approximately 10 years, with a maximum blood pressure of 180/110 mmHg. He was receiving Nifedipine to control blood pressure. The patient had no history of hepatitis, tuberculosis, heart disease, diabetes, trauma, surgery, or blood transfusion.
Physical examination indicated acute facial features, clammy and weakened elastic skin, with T 36.7 C, P 90 beats/min, R 25 beats/min and BP 138/90 mmHg. His abdomen was flat, and the middle and upper abdomen had a moderate tenderness and rebound pain, without muscle tension; however, abdominal moving dullness was strongly positive, and non-coagulated blood was obtained by diagnostic abdominal puncture. Routine blood examination showed the following: WBC 9,800/mm3, RBC 3,200/mm3 (normal range 4,300-5,800/mm3), PLT 91/mm3, HCT 0.311 (normal range 0.400-0.500), HGB: 107 g/L (normal range 130-175 g/dl), and a normal coagulation index. The above results confirmed that the patient had an intraperitoneal hemorrhage combined with moderate anemia.
Abdominal enhanced CT scan revealed the following: 1. Obvious local lumen stenosis was observed at the beginning of the Celiac axis, with a few calcifications on the wall. This was considered as atherosclerosis. Calcified plaques had formed in the abdominal aorta, bilateral common iliac artery, bilateral internal iliac artery, and right external iliac artery, partially accompanied by mural thrombosis (Figure 2A). 2. Hematoma had formed in the upper left abdominal cavity. The boundary between the hematoma and the greater curvature of the gastric wall was unclear, and abdominal pelvic fluid/blood was detected (Figure 2B). The hematoma was 10.2 x 9.5 x 3.3 cm in size, and located in the greater curvature of the stomach. Their boundary was not clear. Surgery involved removal of the mass and partial attachment of the gastric wall with an endoscopic linear cutting stapler (EC60A, Ethicon) (Figure 2C). The postoperative pathological results confirmed the diagnosis of ruptured omental cavernous hemangioma accompanied by thrombosis (Figure 2D). The patient was discharged on postoperative Day 8. No obvious abnormalities were reported and no abnormal findings were detected by blood routine and abdominal CT examination in the 6-month outpatient follow-up period (data not shown).