Egger B, Schweizer W, Wagner H E
Klinik für Viszerale und Transplantationschirurgie, Inselspital Bern.
Helv Chir Acta. 1992 Aug;59(2):399-402.
10 patients with a history of systemic anticoagulation presented with an acute abdomen which proved to be due to a rectus sheath hematoma. Four patients gave a history of antecedent trauma. The prothrombin time was prolonged beyond the therapeutic range in 8 patients and therapeutic in two. The diagnosis of rectus sheath hematoma was made by non-invasive imaging (sonography [n = 8], CT-scan) in 9 patients and by operative exploration in one. 8 patients were treated non-operatively and one patient required a delayed evacuation of the infected hematoma. One patient died from myocardial infarction. We conclude that a careful history, physical examination and prothrombin time, in combination with radiologic evaluation (sonography, CT-scan) can confirm the suspected diagnosis of rectus sheath hematoma. It is important to think of this specific hemorrhagic complication induced by anticoagulation to prevent unnecessary surgery.
10例有全身抗凝治疗史的患者出现急腹症，经证实是由腹直肌鞘血肿所致。4例患者有先前外伤史。8例患者的凝血酶原时间延长超出治疗范围，2例处于治疗范围内。9例患者通过非侵入性成像（超声检查[n = 8]、CT扫描）诊断为腹直肌鞘血肿，1例通过手术探查确诊。8例患者接受非手术治疗，1例患者需要延迟清除感染性血肿。1例患者死于心肌梗死。我们得出结论，详细的病史、体格检查和凝血酶原时间，结合影像学评估（超声检查、CT扫描）可以确诊疑似腹直肌鞘血肿。考虑到这种由抗凝引起的特定出血并发症以防止不必要的手术很重要。
