Department of General Surgery, Alfred Health, Melbourne, Victoria, Australia
Department of Medicine at Alfred Medical Research and Education Precinct, Monash University, Melbourne, Victoria, Australia.
BMJ Case Rep. 2022 Aug 25;15(8):e249913. doi: 10.1136/bcr-2022-249913.
A man in his early 50s presented with a spontaneous large left-sided retroperitoneal haematoma (RPH), on a background of therapeutic anticoagulation with warfarin for homozygous factor V Leiden. His international normalised ratio was found to be supra-therapeutic at 9.0 on presentation. He was treated non-operatively with prompt reversal of the coagulopathy and close monitoring. On day 4 of the admission, the patient reported scrotal pain and swelling. An urgent scrotal ultrasound revealed infarction of the left testis and the patient was taken to an emergency scrotal exploration. Intraoperatively, the left testis was found to be no longer viable with the left spermatic vein and venules completely thrombosed with extensive clots, while the left testicular artery remained intact. Consequently, a left orchidectomy was performed. Therapeutic anticoagulation was recommenced on day 3 postoperatively. It is thought that the large RPH caused extrinsic compression of the left testicular vein, in addition to the patient's pre-existing factor V Leiden, which resulted in thrombosis of the blood vessel.
一名 50 岁出头的男性因接受华法林的治疗性抗凝而出现自发性大型左侧腹膜后血肿（RPH），他携带纯合子因子 V 莱顿突变。就诊时，其国际标准化比值（INR）高达 9.0，超过治疗范围。患者接受了非手术治疗，迅速纠正凝血异常并密切监测。入院第 4 天，患者诉阴囊疼痛和肿胀。紧急阴囊超声显示左侧睾丸梗死，患者被送往急诊阴囊探查。术中发现左侧睾丸已无生机，左侧精索静脉和小静脉完全血栓形成，伴有广泛的血栓，而左侧睾丸动脉保持完整。因此，进行了左侧睾丸切除术。术后第 3 天开始再次进行抗凝治疗。据认为，大型 RPH 除了患者已有的因子 V 莱顿突变外，还对外侧的左侧睾丸静脉造成了压迫，导致血管血栓形成。
