Seseke S, Schreiber M, Rebmann U, Seseke F
Klinik und Poliklinik für Urologie der Georg-August-Universität Göttingen.
Aktuelle Urol. 2008 May;39(3):215-8. doi: 10.1055/s-2007-1016433.
Spontaneous perirenal hematoma is a rare condition. The clinical features are acute flank or abdominal pain, haematuria, hypotension and shock. Bleeding is most commonly caused by renal tumours, especially angiomyolipomas. Other known causes are long-term haemodialysis, arteriosclerosis or arteritis. A total of 6 patients with spontaneous perirenal haemorrhage have been treated in our hospital since 2003. Nearly all patients had been taking anticoagulation medication. One had a bleeding diathesis. One of the patients died immediately after admission at the hospital. All other patients had an exploratory laparotomy. In three cases total nephrectomy had to be performed, two other patients could be treated with partial nephrectomy. In patients with non-traumatic acute flank or abdominal pain it is important to determine whether the patient has been taking anticoagulation medication or suffers from bleeding diathesis because there is a high incidence of bleeding complications in these cases. If an emergent laparotomy is not necessary we recommend that these cases should be treated surgically after clinical stabilisation because tumours are the main reason for the haematomas and the patients have an urgent need for further anticoagulation therapy.
自发性肾周血肿是一种罕见病症。其临床特征为急性胁腹或腹痛、血尿、低血压及休克。出血最常见的原因是肾肿瘤，尤其是血管平滑肌脂肪瘤。其他已知病因包括长期血液透析、动脉硬化或动脉炎。自2003年以来，我院共治疗了6例自发性肾周出血患者。几乎所有患者都在服用抗凝药物。1例有出血素质。其中1例患者入院后立即死亡。所有其他患者均接受了剖腹探查术。3例患者不得不进行全肾切除术，另外2例患者可接受部分肾切除术。对于非创伤性急性胁腹或腹痛患者，确定患者是否一直在服用抗凝药物或患有出血素质很重要，因为这些情况下出血并发症的发生率很高。如果不需要紧急剖腹手术，我们建议这些病例应在临床稳定后进行手术治疗，因为肿瘤是血肿的主要原因，且患者急需进一步的抗凝治疗。
