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背部不寻常的穿透性损伤:玻璃刺伤引起的腹膜后血肿:病例报告。

An unusual penetrating injury of the back: retroperitoneal hematoma from a glass stabbing injury: a case report.

机构信息

Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea.

出版信息

Ann Palliat Med. 2022 Jun;11(6):2157-2161. doi: 10.21037/apm-21-1097. Epub 2021 Aug 2.

Abstract

In stab injury of the back visceral or vascular injuries are more uncommon than anterior abdominal stab injuries. The authors report the case of a 52-year-old man who presented to the emergency center with glass fragments lodged in his back after falling on a glass door on his back. On a retroperitoneal computed tomography (CT) scan, two foreign bodies were detected in left paraspinal and psoas muscles. Furthermore, hematoma with active bleeding was seen in the retroperitoneal cavity. He was referred to a general surgeon for retroperitoneal active bleeding, but emergency laparotomy was not deemed necessary considering the patient's stable condition in terms of vital signs, the level of hemoglobin, and the amount of bleeding. Therefore, we performed conservative treatment, such as packed cell transfusion and back compression, after removing the glass fragment through the posterior approach. The paravertebral muscle was dissected through the open wound, the tip of the piece of glass was accessible. The piece of glass was carefully removed, and there was no active bleeding. The postoperative CT scan showed continued active bleeding and increased retroperitoneal hematoma, but the patient's vital signs were stable. Conservative treatment was administered continuously, a follow-up CT scan taken a month later showed hematoma resolution and no more dye leakage. If the patient's vital signs are stable and the patient is neurologically intact, conservative treatment may be prioritized without laparotomy.

摘要

在背部刺伤中,内脏或血管损伤比前腹部刺伤少见。作者报告了一例 52 岁男性的病例,该患者背部摔在玻璃门上后,背部有玻璃碎片嵌入。在腹膜后计算机断层扫描(CT)上,在左脊柱旁肌和腰大肌中发现了两个异物。此外,腹膜后腔可见血肿伴活动性出血。由于患者的生命体征、血红蛋白水平和出血量稳定,他被转介给普外科医生治疗腹膜后活动性出血,但考虑到患者的稳定情况,紧急剖腹手术被认为是不必要的。因此,我们通过后路去除玻璃碎片后进行了保守治疗,如输红细胞和背部压迫。通过开放性伤口解剖椎旁肌,可触及玻璃碎片的尖端。小心地取出玻璃碎片,没有活动性出血。术后 CT 扫描显示持续活动性出血和腹膜后血肿增加,但患者的生命体征稳定。持续进行保守治疗,一个月后进行的后续 CT 扫描显示血肿消退,无染料漏出。如果患者的生命体征稳定且神经功能完整,可能优先选择保守治疗而不是剖腹手术。

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