一名接受抗凝治疗的患者因腹直肌鞘巨大血肿导致出血性休克和梗阻性尿路病。

Hemorrhagic shock and obstructive uropathy due to a large rectus sheath hematoma in a patient on anticoagulant therapy.

作者信息

Toyonaga Jiro, Tsuruya Kazuhiko, Masutani Kohsuke, Maeda Hiroto, Nakamura Kuniyuki, Taniguchi Masatomo, Hirakata Hideki, Iida Mitsuo

机构信息

Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka.

出版信息

Intern Med. 2009;48(24):2119-22. doi: 10.2169/internalmedicine.48.2440.

DOI:10.2169/internalmedicine.48.2440

PMID:20009404

Abstract

A 54-year-old woman was transferred to our hospital with disseminated intravascular coagulation, and was treated with heparin. On hospitalization day 13, she developed lower abdominal pain and mass followed by circulatory shock. She became oliguric and laboratory tests showed serum creatinine of 3.5 mg/dL and hemoglobin of 7.4 g/dL. Computed tomography showed hematoma in the left rectus sheath, compressing the urinary bladder exteriorly, which resulted in worsening of bilateral hydronephrosis. Conservative treatment resulted in resolution of the rectus sheath hematoma and improvement of renal function. Rectus sheath hematoma can be treated conservatively without surgical intervention even in complicated cases.

摘要

一名54岁女性因弥散性血管内凝血被转至我院，并接受肝素治疗。住院第13天，她出现下腹部疼痛和肿块，随后发生循环性休克。她出现少尿，实验室检查显示血清肌酐为3.5mg/dL，血红蛋白为7.4g/dL。计算机断层扫描显示左腹直肌鞘内血肿，向外压迫膀胱，导致双侧肾积水加重。保守治疗使腹直肌鞘血肿消退，肾功能改善。即使在复杂病例中，腹直肌鞘血肿也可通过保守治疗而无需手术干预。