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Laceration of the transverse mesocolon in an old man with a habit of abdominal massage for constipation: a case report

updated

Tags: massage, case, harms, manual therapy, treatment, pain problems

Four articles on PainSci cite Mori 2020: (1) Does Massage Therapy Work?(2) The Pressure Question in Massage Therapy(3) Massage Therapy Side Effects(4) Psoas, So What?

PainSci summary of Mori 2020: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

This is a description of a case of intestinal injury following self-massage of the abdomen intended to help constipation. A 68-year-old man with chronic constipation had a habit of abdominal self-massage, and “did it hard” shortly before developing severe belly pain. He was misdiagnosed with a tumour at the hospital. A day later, still bleeding internally, a surgeon found a litre and a half of blood and a five centimetre tear in his upper colon. The patient recovered surprisingly well after an imperfect repair — the intestinal tissue was too fragile to stitch the tear closed properly. His only complication was an ironic increase in constipation from a paralyzed intestine. When traumatized, the intestine stops contracting for safety.

The authors of the report reasonably assume that the injury was caused by the self-massage, but note other possible explanations, “such as rupture of small aneurysms.” However, the lesion was quite a bit too large to be explained by anything but the most obvious.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Abdominal massage for the resolution of constipation has been reported to be safe and recommended in some studies. It is conventionally performed for the elderly suffering from intractable constipation. Meantime, isolated mesenteric injury after blunt abdominal trauma is uncommon. Here, we report a case of isolated mesenteric injury following self-abdominal massage for constipation.

CASE PRESENTATION: A 68-year-old man consulted a local hospital due to a sudden abdominal pain. He had a history of prostate cancer treated with radiation therapy 3 years ago, and he had been suffering from chronic constipation for many years. A plain computed tomography (CT) revealed a fist-sized homogeneous mass-like lesion located in the left upper abdomen and a moderate amount of ascites. With the initial diagnosis of a malignant tumor accompanied by peritonitis carcinomatosa, he was hospitalized for further examinations. On the next day, his hemoglobin concentration dropped from 11.6 to 6.6 g/dl, and diagnostic paracentesis showed bloody ascites. He was urgently transferred to our tertiary emergency center. An enhanced CT demonstrated a non-enhanced, homogeneous, 8.5 cm in diameter, mass lesion located to the posterior of the stomach with massive bloody ascites. He underwent an emergency exploratory laparotomy, and it showed a 5 cm of laceration in the transverse mesocolon adjacent to Treitz's ligament and approximately 1.5 l of intraabdominal hemorrhage. Hemostasis of the bleeding from the laceration was achieved by suture ligations, but the gap of the laceration could not be closed by suturing because the tissue was too fragile. Blood transfusion with 4 units of packed red blood cells and 10 units of fresh frozen plasma was performed during operation. He was discharged without any significant complications except for postoperative paralytic ileus. Later on, it turned out that he had a habit of massaging his abdomen for the resolution of intractable constipation and did it hard 1 day before the onset.

CONCLUSIONS: This is the first report of life-threatening mesenteric injury caused by self-abdominal massage to resolve constipation, though other etiologies such as rupture of small aneurysms could not perfectly be excluded. Abdominal massage is reported to be effective and safe for the resolution of constipation; however, this case demonstrated it could be detrimental.

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