When the colon takes a hit: a rare case of acute colonic intramural hematoma after blunt abdominal trauma.

Acute colonic intramural hematomas are rare but clinically significant. They are associated with anticoagulation use, coagulopathies, and trauma. We report a case of a 20-year-old male who was referred to the trauma hospital from an outside institution with right lower quadrant pain and a palpable mass the day of a motor vehicle accident. Computed tomography and magnetic resonance imaging showed an intramural colonic hematoma (measuring 8.3 cm AP × 10.7 cm TR × 13.8 cm long). The patient was initially managed conservatively due to stable hemodynamic status and normal hemoglobin levels. However, the patient's clinical status deteriorated and therefore underwent surgical intervention. Exploratory laparotomy confirmed a large intramural hematoma with a ruptured lateral cecal/ascending colonic wall. An open right hemicolectomy with ileocolonic anastomosis was performed. The final pathologic diagnosis was a hemorrhagic infarction of the colon. The patient recovered well and was discharged home 7 days after surgery.