Read Phillipa, Walker Patrick, Menon Tulsi
Department of General Surgery, Royal Perth Hospital, Perth, WA 6000, Australia.
J Surg Case Rep. 2023 Feb 2;2023(2):rjad023. doi: 10.1093/jscr/rjad023. eCollection 2023 Feb.
Spontaneous haemoperitoneum (SH) is a rare but life-threatening condition with several well-recognized causes. SH often occurs in anticoagulated patients and requires urgent treatment to prevent mortality. SH is rarely associated with infective endocarditis (IE). To date, there are no reported cases of a haemorrhagic mesenteric abscess causing haemoperitoneum. We present the case of a warfarinized 30-year-old intravenous drug user with IE 2 weeks post-revision of a metallic valve who reported abdominal pain and subsequently suffered haemodynamic collapse. Abdominal computed tomography and damage-control laparotomy revealed haemoperitoneum secondary to an actively bleeding mesenteric nodule which was resected. Histopathology confirmed a haemorrhagic mesenteric abscess representing a rare sequela of IE and a novel cause of SH. Given that the incidence of IE appears to be increasing in people who inject drugs in Australia, the general surgeon should be aware of this clinical entity and the need for urgent intervention to prevent catastrophic sequelae.
自发性血腹（SH）是一种罕见但危及生命的疾病，有多种公认的病因。SH常发生于接受抗凝治疗的患者，需要紧急治疗以防止死亡。SH很少与感染性心内膜炎（IE）相关。迄今为止，尚无出血性肠系膜脓肿导致血腹的报道病例。我们报告一例30岁接受华法林治疗的静脉吸毒者，在金属瓣膜置换术后2周发生IE，出现腹痛，随后发生血流动力学崩溃。腹部计算机断层扫描和损伤控制剖腹术显示血腹继发于一个活动性出血的肠系膜结节，该结节被切除。组织病理学证实为出血性肠系膜脓肿，这是IE的一种罕见后遗症，也是SH的一种新病因。鉴于澳大利亚注射毒品人群中IE的发病率似乎在上升，普通外科医生应了解这一临床实体以及紧急干预以预防灾难性后果的必要性。
