A 61-year-old female was admitted to our hospital on September 16, 2018 due to persistent dull pain in the middle and upper abdomen for > 2 months, with aggravation for 1 day. The pain was relieved after taking an oral anodyne (specific name and dosage unknown) prescribed by a local physician, and no further examination or treatment was given. She denied any history of hypertension, diabetes, hepatitis, tuberculosis, heart disease, abdominal trauma, or operation. Physical examination showed the patient had acute facial features and pallid eyelid conjunctiva, and her skin was clammy and less elastic, with a body temperature (T) of 36.5 C, pulse frequency (P) of 80 beats/min, respiration frequency (R) of 20 beats/min and blood pressure (BP) of 126/80 mmHg. Abdominal moving dullness was positive, and non-coagulated blood was extracted by diagnostic abdomen puncture.
Routine blood examination revealed the following: white blood cell count (WBC) of 9,800/mm3 (normal range 4,000-10,000/mm3), red blood cell count (RBC) of 3,100/mm3 (normal range 3,800-5,100/mm3), platelet (PLT) of 130/mm3 (normal range 100-300/mm3), Hematocrit (HCT) of 0.283 (normal range 0.350-0.450), and a hemoglobin (HGB) concentration of 91 g/dl (normal range 115-150 g/dl). No abnormality was found on coagulation function examination. The above results indicated that the patient had an intraperitoneal hemorrhage combined with moderate anemia.
Abdominal enhanced computed tomography (CT) revealed an effusion in the abdomen and pelvis, suspicious blood accumulation around the liver and spleen, and a slightly patchy high-density shadow on the side of the great curvature of the gastric body, about 9.8 x 6.9 x 6.5 cm in size (Figure 1A). Emergency laparoscopic exploration was subsequently performed. During the procedure, about 1,400 ml of bloody fluid was found in the abdominal pelvic cavity, and an elliptical mass about 10.1 x 8.2 x 8.0 cm in size, with a surrounding blood clot was detected in the omentum of the greater curvature of the gastric body (Figure 1B). The boundary of the mass was unclear, and accompanied by active hemorrhage, which was difficult to separate from the greater curvature of the gastric body. Therefore, the mass and the attached wedge-shaped stomach wall were simultaneously removed by an endoscopic linear cutting stapler (EC60A, Ethicon) (Figure 1C). Hemostasis, anti-infection, and symptomatic treatment were provided postoperatively. Postoperative pathological examination revealed an omental capillary hemangioma with hemorrhage (Figure 1D), and the patient was discharged on postoperative Day 7. No complaints of special discomfort were mentioned, and no abnormal findings were found on routine blood and abdominal CT examination in the 1 year followed-up period (data not shown).