一例未经治疗的原发性甲状旁腺功能减退患者实施急性冠状动脉综合征（ACS）方案后出现复杂血肿形成的病例。
A CASE OF COMPLEX HEMATOMA FORMATION AFTER INSTITUTION OF ACS PROTOCOL IN A PATIENT WITH UNTREATED PRIMARY HYPOPARATHYROIDISM.
作者信息
Ahsan Tasnim, Sohail Erum, Memon Amjad Siraj, Sheikh Masood, D'Souza Glenis Piedade, Ghaus Saima
出版信息
AACE Clin Case Rep. 2019 Jun 7;5(5):e267-e270. doi: 10.4158/ACCR-2019-0021. eCollection 2019 Sep-Oct.
OBJECTIVE
We report an unusual case of untreated hypoparathyroidism in which the patient presented with a prolonged QT interval and unusual bleeding after the institution of acute coronary syndrome (ACS) protocol.
METHODS
A 53-year-old female presented with sudden pain and diffuse tightness in the abdomen/limbs and profuse sweating for a few hours. Patient was admitted under cardiology services and ACS protocol was instituted.
RESULTS
After 2 days of admission, she developed severe abdominal pain and distention, which was due to large hematomas in the bladder wall, rectus sheath, and retroperitoneal area. These hematomas were surgically drained, but the abdominal wall could not be closed due to gut distention and stiffness of the abdominal wall; a Bogota bag was applied for closure. The patient was shifted to oral calcium after 12 days of intravenous calcium and vitamin D replacement. Abdominal closure was done several weeks later as a follow-up procedure.
CONCLUSION
This case illustrates the neglected areas of the impact of hypoparathyroidism; the effects of chronic hypocalcemia on the cardiovascular system and coagulation cascade.
目的
我们报告一例未经治疗的甲状旁腺功能减退症的罕见病例，该患者在实施急性冠状动脉综合征（ACS）方案后出现QT间期延长和异常出血。
方法
一名53岁女性出现腹部/四肢突然疼痛和弥漫性紧绷感，并大量出汗数小时。患者入住心脏病科并实施ACS方案。
结果
入院2天后，她出现严重腹痛和腹胀，这是由于膀胱壁、腹直肌鞘和腹膜后区域出现大血肿所致。这些血肿通过手术引流，但由于肠道扩张和腹壁僵硬，腹壁无法缝合；应用了波哥大袋进行封闭。在静脉补钙和维生素D替代治疗12天后，患者改为口服钙剂。几周后作为后续程序进行了腹壁缝合。
结论
本病例说明了甲状旁腺功能减退症影响的被忽视领域；慢性低钙血症对心血管系统和凝血级联反应的影响。
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