George Jayan, Ben-Sassi Abozed, Dixon Rebecca
Respiratory Department, Abertawe Bro Morgannwg University Health Board, Swansea, UK.
Department of General Surgical Directorate, Wrexham Maelor Hospital, Wrexham, UK.
BMJ Case Rep. 2014 Dec 5;2014:bcr2014207849. doi: 10.1136/bcr-2014-207849.
Spontaneous haemoperitoneum is rare. When it occurs it is a life-threatening condition. Common causes of this are gynaecological in nature and rarely due to colonic diverticular perforation. Diverticulitis is a common condition affecting people in western countries. This presentation of spontaneous haemoperitoneum highlights the disproportionate abdominal pain and opioid-induced constipation. Significant bloods on admission included haemoglobin of 148 g/L, C reactive protein (CRP) of 1.1 mg/L, white cell count (WCC) of 12.7×10(9)/L (neutrophils 10.9×10(9)/L). Bloods repeated 10 h later revealed the haemoglobin had dropped to 100 g/L, CRP had increased significantly to 120 mg/L, WCC: 7.4×10(9)/L (neutrophils 5.3×10(9)/L) and a reduced packed cell volume: 0.307 L/L. CT scan revealed free fluid and a possible mass. At laparoscopy, frank haemoperitoneum was seen and a decision was made to open and perform a Hartmann's procedure. The patient did very well postoperatively and was discharged on the ninth postoperative day. He is currently awaiting reversal of the ileostomy.
自发性血腹症较为罕见。一旦发生，它是一种危及生命的状况。其常见病因多为妇科方面，极少由结肠憩室穿孔引起。憩室炎是西方国家人群中的常见病症。这种自发性血腹症的表现突出了不成比例的腹痛和阿片类药物引起的便秘。入院时的重要血液检查结果包括血红蛋白148 g/L、C反应蛋白（CRP）1.1 mg/L、白细胞计数（WCC）12.7×10⁹/L（中性粒细胞10.9×10⁹/L）。10小时后复查血液显示血红蛋白降至100 g/L，CRP显著升高至120 mg/L，WCC：7.4×10⁹/L（中性粒细胞5.3×10⁹/L），血细胞比容降低至0.307 L/L。CT扫描显示有游离液体和一个可能的肿块。在腹腔镜检查时，可见明显的血腹，于是决定转为开腹并进行哈特曼手术。患者术后恢复良好，术后第九天出院。他目前正在等待回肠造口术的回纳。
