부산대학교 도서관

The patient was a 27–year–old male, who was transported to our hospital after he was involved in a traffic accident caused by altered sensorium while he was driving to the hospital for 3–day history of worsening abdominal pain. Abdominal ultrasonography showed massive intra–abdominal hemorrhage, and contrast–enhanced computed tomography revealed a hemorrhagic mass between the tail of the pancreas and the hepatic flexure of the colon. The patient was diagnosed as having either rupture of a branch of the splenic artery or hemorrhage from the tumor in the pancreatic tail, and underwent emergency laparotomy. During surgery, active bleeding was seen from the tumor measuring 4 cm in diameter in the tail of the pancreas. As the tumor was found to be tightly adherent to the splenic flexure of the colon, distal pancreatectomy and partial colectomy, including the tumor, were performed. Histopathology of the resected specimen suggested that the tumor originated in the mesentery of the colon. Histologically, the tumor was found to be composed of proliferating spindle–shaped cells, and to invade a branch of the splenic artery. Immunostaining showed negative staining of the tumor for ALK, CD34, c–kit, desmin, DOG–1, S–100, SMA, and STAT6, and positive staining for only β–catenin. Therefore, the tumor was diagnosed as a desmoid tumor. From the clinical course and intraoperative findings, it was thought that the hematoma formed as a result of invasion by the tumor of a branch of the splenic artery which then ruptured into the abdominal cavity, causing the worsening abdominal pain and altered consciousness. The patient had a favorable postoperative course and was discharged from the hospital on day 27. There have been only a few reports of desmoid tumors with hemorrhage. We report this case with some review of the literature.