Jose Paul, Achuthan Raj, Sagar Peter
Leeds General Infirmary, General Surgery, D-156, Clarendon Wing, Leeds LS1 3EX, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.08.2008.0658. Epub 2009 May 25.
A 73-year-old man presented with features of acute abdomen 2 days following evacuation of a subdural haematoma. CT scan demonstrated significant free fluid in the peritoneal cavity as well as an extensive abnormal area in the upper retroperitoneum. There was no obvious free gas or leak of contrast. As there was persistent metabolic acidosis and significant peritonism, the patient proceeded to an exploratory laparotomy. This revealed a large non-expanding retroperitoneal haematoma and free blood in the peritoneal cavity. There was no evidence of active bleeding and the bowel was found to be viable. As the patient was haemodynamically stable, a laparostomy was fashioned and the patient subsequently underwent angiography. This revealed a 1.5 cm pseudoaneurysm arising from the superior mesenteric artery which was treated with coil embolisation. The patient made an uneventful recovery and the laparostomy was closed.
一名73岁男性在硬膜下血肿清除术后2天出现急腹症症状。CT扫描显示腹腔内有大量游离液体，以及上腹膜后广泛的异常区域。没有明显的游离气体或造影剂渗漏。由于持续存在代谢性酸中毒和明显的腹膜炎体征，患者接受了剖腹探查术。术中发现一个巨大的、无扩展的腹膜后血肿以及腹腔内的游离血液。没有活动性出血的迹象，肠管血运良好。由于患者血流动力学稳定，进行了剖腹造口术，随后患者接受了血管造影。结果显示肠系膜上动脉有一个1.5厘米的假性动脉瘤，采用弹簧圈栓塞治疗。患者恢复顺利，剖腹造口术关闭。
