Kwon Lawrence
Nephrology, Westchester Medical Center, Poughkeepsie, NY, USA.
Biomed Hub. 2024 May 27;9(1):89-93. doi: 10.1159/000538709. eCollection 2024 Jan-Dec.
Rectus sheath hematomas (RSHs) can occur from the rupture of the epigastric arteries, leading to blood accumulation within the rectus abdominis sheath. Herein, we report the unique case of an RSH resulting in acute ureteral obstruction, which was associated with the use of a handheld deep-tissue percussive massage device in attempts to relieve abdominal pain.
A morbidly obese man in his late 50s was admitted with complications of COVID-19, including acute respiratory syndrome, bilateral peroneal deep vein thromboses, and acute kidney injury. He was treated with anticoagulants (subcutaneous enoxaparin and apixaban), dexamethasone, and remdesivir. He developed severe abdominal pain, and a large (14 × 17 cm) right rectus sheath and an extraperitoneal pelvic hematoma were identified by computed tomography. The hematoma extended across the midline into the left pelvis and the retroperitoneum with associated mild right hydronephrosis. A handheld percussive massage device (Theragun) was applied repeatedly at the site of enoxaparin injection into the abdominal wall in attempts to alleviate the pain. On day 12, bilateral nephrostomy tubes were inserted. A nephrostogram revealed mild hydroureteronephrosis to the ureterovesicular junction bilaterally and extrinsic compression of the bladder. On day 17, the patient suffered a cardiac arrest and died.
This case report offers insights into the pathophysiology of obstructive uropathy and is a reminder of the importance of considering uncommon causes of obstructive uropathy in the diagnosis and management of AKI, particularly in hospitalized patients receiving anticoagulation. We know of no previous reference of obstructive uropathy caused by retroperitoneal hematoma associated with the use of a portable massage device applied to the abdominal wall.
腹直肌鞘血肿（RSH）可由腹壁上动脉破裂引起，导致血液积聚在腹直肌鞘内。在此，我们报告一例罕见的腹直肌鞘血肿导致急性输尿管梗阻的病例，该病例与使用手持式深部组织冲击按摩器缓解腹痛有关。
一名50多岁的病态肥胖男性因新型冠状病毒肺炎（COVID-19）并发症入院，包括急性呼吸综合征、双侧腓深静脉血栓形成和急性肾损伤。他接受了抗凝治疗（皮下注射依诺肝素和阿哌沙班）、地塞米松和瑞德西韦治疗。他出现了严重的腹痛，计算机断层扫描发现一个巨大的（14×17厘米）右侧腹直肌鞘和腹膜外盆腔血肿。血肿越过中线延伸至左盆腔和腹膜后，伴有轻度右侧肾盂积水。为缓解疼痛，在腹壁依诺肝素注射部位反复使用手持式冲击按摩器（Theragun）。第12天，插入双侧肾造瘘管。肾造瘘造影显示双侧输尿管膀胱连接处轻度肾盂输尿管积水以及膀胱外部受压。第17天，患者发生心脏骤停并死亡。
本病例报告为梗阻性肾病的病理生理学提供了见解，并提醒我们在急性肾损伤的诊断和管理中，尤其是在接受抗凝治疗的住院患者中，考虑梗阻性肾病不常见病因的重要性。我们之前未发现因使用应用于腹壁的便携式按摩器导致腹膜后血肿引起梗阻性肾病的相关报道。
