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急性袖套手术后出血致急性肾衰竭罕见病因:1 例报告。

Acute post sleeve surgery bleeding as rare cause of acute renal failure: a case report.

机构信息

Department of the General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Clinical Research Development Unit of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

出版信息

J Med Case Rep. 2023 Jul 5;17(1):281. doi: 10.1186/s13256-023-03978-y.

Abstract

BACKGROUND

Bariatric surgeries have been considered as one of the most important treatment procedures in recent years. Being aware of the side effects of this surgery will lead to better results after the surgery.

CASE PRESENTATION

A 37-year-old Iranian male patient presented one day after sleeve surgery with symptoms of weakness, lethargy, and shortness of breath, which hospitalization and workup to were done to rule out pulmonary embolism. Because of the high creatinine and anuria, we couldn't perform computed tomography angiography. A bedside ultrasound was done for the patient and showed a mild to moderate amount of fluid around the spleen and some blood clots. Due to the progressive clinical findings and suspected internal bleeding, the patient was a candidate for laparoscopic revision procedure. Gradually, after performing the surgery, removing the blood clot and reducing the compressive effect of that on the inferior verna cava which was the main reason of renal failure, the patient was able to urinate afterwards and was discharged in good general condition.

CONCLUSION

Surgeons should be aware of the management of rare surgical complications after bariatric surgeries. To be best of our knowledge, this was the first case report of a patient with acute renal failure after bariatric surgery and the rare cause of clot compression on inferior vena cava and raised abdominal compartment pressure.

摘要

背景

近年来,减重手术已被视为最重要的治疗方法之一。了解该手术的副作用将有助于术后取得更好的效果。

病例介绍

一名 37 岁的伊朗男性患者在袖状胃切除术后一天出现虚弱、嗜睡和呼吸急促的症状,因此住院并进行了检查以排除肺栓塞。由于肌酐升高和无尿,我们无法进行 CT 血管造影。为患者进行床边超声检查显示脾脏周围有轻度至中度积液和一些血块。由于进行性临床发现和疑似内出血,患者成为腹腔镜修正手术的候选人。逐渐地,在进行手术后,清除了血块,减轻了对下腔静脉的压迫作用,下腔静脉是导致肾衰竭的主要原因,患者随后能够排尿并在良好的一般状况下出院。

结论

外科医生应该意识到减重手术后罕见的手术并发症的处理。据我们所知,这是首例报道的减重手术后急性肾衰竭患者,罕见的原因是下腔静脉血块压迫和腹部高压。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f2ae/10320934/f2a7803ffaa9/13256_2023_3978_Fig1_HTML.jpg

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