{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T05:52:21Z","timestamp":1774158741229,"version":"3.50.1"},"reference-count":17,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,3]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>Spontaneous mesenteric bleeding is an exceptionally rare clinical condition and potentially lethal especially among elderly patients who are taking oral anticoagulant. We present a case of a 79-year-old woman who presented to the emergency department with atypical chest pain which was radiating to the back. She developed profound hypotension with a sudden drop of haemoglobin. Contrast-enhanced CT of the aorta showed active mesenteric bleeding with mesenteric haematoma. The early diagnosis relies solely on a high index of suspicion of occult bleeding in patients with unexplained hypotension with a sudden drop of haemoglobin. Troponin can be falsely positive in mesenteric bleeding. Close monitoring to detect any sign of deterioration and early imaging in diagnosing intra-abdominal bleeding can help to avoid delay in treatment which is essential to prevent mortality and morbidity.<\/jats:p>","DOI":"10.1136\/bcr-2021-244051","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T12:55:57Z","timestamp":1628859357000},"page":"e244051","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Atypical presentation of catastophric spontaneous mesenteric bleeding"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1951-6598","authenticated-orcid":false,"given":"May Honey","family":"Ohn","sequence":"first","affiliation":[{"name":"Cardiology department, Lewisham Hospital NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8923-0344","authenticated-orcid":false,"given":"Jun Rong","family":"Ng","sequence":"additional","affiliation":[{"name":"Faculty of medicine and health sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ng Pey","family":"Luen","sequence":"additional","affiliation":[{"name":"Emergency department, Miri Hospital, Miri, Sarawak, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khin Maung","family":"Ohn","sequence":"additional","affiliation":[{"name":"Surgery department, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,13]]},"reference":[{"key":"2025082709595195000_14.8.e244051.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-003-9108-y"},{"key":"2025082709595195000_14.8.e244051.2","first-page":"147","article-title":"[Abdominal bleeding due to spontaneous mesenteric vein rupture]","volume":"36","author":"Garc\u00eda","year":"2006","journal-title":"Acta Gastroenterol Latinoam"},{"key":"2025082709595195000_14.8.e244051.3","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0021-7697(07)89494-4","article-title":"[Spontaneous haemoperitoneum due to a ruptured intra-abdominal varix with cirrhosis: report of two cases]","volume":"144","author":"Puche","year":"2007","journal-title":"J Chir"},{"key":"2025082709595195000_14.8.e244051.4","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1984.01390190099023"},{"key":"2025082709595195000_14.8.e244051.5","first-page":"1141","article-title":"Case of a bleeding pseudoaneurysm of the middle colic artery complicating acute pancreatitis","volume":"49","author":"Toyonaga","year":"2002","journal-title":"Hepatogastroenterology"},{"key":"2025082709595195000_14.8.e244051.6","first-page":"196","article-title":"Spontaneous rupture of mesenteric hematoma with hemorrhagic shock as a complication of oral anticoagulant treatment","volume":"1","author":"Becker","year":"1999","journal-title":"Isr Med Assoc J"},{"key":"2025082709595195000_14.8.e244051.7","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.ijscr.2018.02.008","article-title":"Spontaneous mesenteric hematoma of the sigmoid colon associated with rivaroxaban: a case report","volume":"44","author":"Hirano","year":"2018","journal-title":"Int J Surg Case Rep"},{"key":"2025082709595195000_14.8.e244051.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-011-0128-z"},{"key":"2025082709595195000_14.8.e244051.9","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.11110326"},{"key":"2025082709595195000_14.8.e244051.10","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.ijscr.2016.05.034","article-title":"Report of a case with a spontaneous mesenteric hematoma that ruptured into the small intestine","volume":"24","author":"Shikata","year":"2016","journal-title":"Int J Surg Case Rep"},{"key":"2025082709595195000_14.8.e244051.11","doi-asserted-by":"crossref","unstructured":"Tanioka N , Maeda H , Tsuda S , et al . A case of spontaneous mesenteric hematoma with diagnostic difficulty. 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