Sugiura Gaku, Bunya Naofumi, Yamaoka Ayumu, Okuda Hiroki, Saito Masato, Mizuno Hirotoshi, Inoue Hiroyuki, Narimatsu Eichi
Department of Emergency Medicine Sapporo Medical University Sapporo Hokkaido Japan.
Present address: Emergency and Critical Care Medical Center Teine Keijinkai Hospital 1-Jo 12-Chome 1-40, Maeda, Teine-ku Sapporo Hokkaido 006-8555 Japan.
Acute Med Surg. 2019 Jan 10;6(2):180-184. doi: 10.1002/ams2.385. eCollection 2019 Apr.
There are several reports of retroperitoneal hemorrhage induced by percutaneous femoral cannulation for extracorporeal membrane oxygenation (ECMO). However, there are no reports of delayed retroperitoneal hemorrhage, which develops a few days after ECMO initiation and is unrelated to the ECMO cannulation. Herein, we report a rare case of delayed retroperitoneal hemorrhage during veno-venous extracorporeal membrane oxygenation (VV-ECMO).
A 54-year-old man was referred to our hospital because of severe acute respiratory distress syndrome. We initiated VV-ECMO. The patient had severe delirium and was confined to a long-term supine position to maintain circuit safety. On day 13, computed tomography unexpectedly revealed a large retroperitoneal hemorrhage spreading around the psoas muscle.
Delayed retroperitoneal hemorrhage can develop during VV-ECMO management a few days after its initiation. Anticoagulant use and forceful muscular strain could be risk factors of delayed retroperitoneal hemorrhage.
有几篇关于体外膜肺氧合（ECMO）经皮股动脉插管引起腹膜后出血的报道。然而，尚无关于延迟性腹膜后出血的报道，这种出血在启动ECMO几天后发生，且与ECMO插管无关。在此，我们报告一例静脉-静脉体外膜肺氧合（VV-ECMO）期间罕见的延迟性腹膜后出血病例。
一名54岁男性因严重急性呼吸窘迫综合征转诊至我院。我们启动了VV-ECMO。患者有严重谵妄，为维持管路安全长期处于仰卧位。在第13天，计算机断层扫描意外发现大量腹膜后出血，血肿蔓延至腰大肌周围。
延迟性腹膜后出血可在VV-ECMO治疗过程中启动几天后发生。使用抗凝剂和强力肌肉拉伤可能是延迟性腹膜后出血的危险因素。
