Pera Miguel, Real Isabel M, Pascual Marta, Martinez Isidro, Grande Luis
Colorectal Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain.
Colorectal Surgery Unit, Department of Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
Eur J Trauma Emerg Surg. 2007 Feb;33(1):87-9. doi: 10.1007/s00068-007-5125-x. Epub 2007 Feb 24.
Severe pelvic hemorrhage after blunt trauma without bony fracture has been reported occasionally, and clinical presentation as a delayed massive rectal bleeding is very rare.
The case of an 86-year-old woman with massive rectal bleeding 12 h after mild blunt perineal trauma is presented. Physical examination revealed an extensive perineal hematoma and a 2-cm laceration in the posterior rectal wall. Pelvic CT scan revealed a large mesorectal hematoma causing extrinsic compression of the rectal lumen. No bony fracture was observed. Selective arteriography was then performed showing hemorrhage resulting from the right middle hemorrhoidal artery, branch of the internal pudendal artery. Transcatheter embolization of coils successfully controlled the bleeding. However, the patient developed a respiratory distress syndrome and renal failure with no response to the treatment and she died 3 days later.
This report is unique not only for the unusual association of pelvic hemorrhage and rectal injury after blunt trauma without pelvic fracture but also because of the clinical presentation as a massive rectal bleeding. Undoubtedly, the delayed diagnosis and treatment, 12 h after the trauma, contributed to the fatal outcome.
钝性创伤后无骨盆骨折但发生严重骨盆出血的情况偶尔有报道，而临床表现为延迟性大量直肠出血则极为罕见。
本文介绍了一名86岁女性的病例，该患者在轻度钝性会阴部创伤12小时后出现大量直肠出血。体格检查发现广泛的会阴部血肿以及直肠后壁一处2厘米的裂伤。骨盆CT扫描显示巨大的直肠系膜血肿导致直肠腔外部受压。未观察到骨盆骨折。随后进行了选择性动脉造影，显示出血源自阴部内动脉分支右中痔动脉。经导管线圈栓塞成功控制了出血。然而，患者出现了呼吸窘迫综合征和肾衰竭，治疗无效，3天后死亡。
本报告不仅因其钝性创伤后无骨盆骨折却出现骨盆出血与直肠损伤的不寻常关联而独特，还因其临床表现为大量直肠出血。毫无疑问，创伤后12小时的延迟诊断和治疗导致了致命结局。
