• 1 Cardiology department, Lewisham Hospital NHS Trust, London, UK
  • 2 Faculty of medicine and health sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
  • 3 Emergency department, Miri Hospital, Miri, Sarawak, Malaysia
  • 4 Surgery department, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
BMJ Case Rep, 2021 Aug 13;14(8).
PMID: 34389596 DOI: 10.1136/bcr-2021-244051


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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.