Spontaneous mesenteric hemorrhage following a sneezing episode associated with an intestinal pseudodiverticulum: a case report

Introduction: Spontaneous mesenteric hemorrhage (SMH) is a rare and potentially life-threatening cause of acute abdominal pain. It is defined as bleeding into the mesentery in the absence of trauma or iatrogenic injury. Diagnosis is challenging due to nonspecific clinical presentation and imaging findings that may mimic bowel ischemia or neoplasia. Case presentation: A 45-year-old man, known for heavy smoking and untreated hypertension, presented with acute diffuse abdominal pain following a forceful sneezing episode. Physical examination revealed localized peritoneal signs. Contrast-enhanced CT demonstrated a mesenteric hemorrhage associated with moderate hemoperitoneum and focal mural hypoenhancement of an ileal loop, without active arterial extravasation. Urgent surgical exploration revealed approximately 500 mL of hemoperitoneum, a large mesenteric hematoma, and an adjacent intestinal pseudodiverticulum. Segmental small bowel resection, including the diverticulum, was performed. Histopathological analysis confirmed fresh mesenteric hemorrhage and pseudodiverticular changes without evidence of malignancy, vasculitis, or vascular malformation. The immediate postoperative course was uneventful; nevertheless, the patient developed a symptomatic incisional hernia. Discussion: SMH is a rare cause of acute abdomen that may occur in otherwise healthy individuals. In this case, the condition was observed in temporal association with a forceful sneezing episode. The presence of an adjacent intestinal pseudodiverticulum and patient-specific vascular risk factors, including hypertension and heavy smoking, may have contributed to local vascular fragility and bleeding. However, a clear causal relationship cannot be established. Awareness of this rare entity may facilitate timely diagnosis and appropriate management. Conclusions: This case highlights a rare presentation of SMH, with multiple potential contributing factors.