頸髓損傷病人出現遲發性脾破裂：病例報告

本文報告一65歲因交通意外導致不完全頸髓損傷的男性病人。在受傷前身體並沒有什麼不適，因交通意外入院，當時沒有失去意識，除四肢無力外，另有臉部多處擦傷及左顴骨骨折，右肘擦傷。經頸椎核磁共振檢查爲頸部第四第五節間、第五第六節間椎間盤突出。經開刀固定頸椎後，轉入復健科接受復健。轉入時爲四肢無力，大小便能自解。病人在復健科住院時，進行坐姿平衡及墊上運動的治療訓練。在復健期間，病人曾敘及上肢酸痛及四肢無力，亦曾因有左膝關節痛服用止痛劑，其他並無不適。經二十天復健後，突感呼吸困難及腹部腫脹、意識不清約一分鐘，並冒冷汗及胸悶，血紅素由11.7g/dL急降至6.4g/dL，經腹部電腦斷層爲脾破裂及腹部出血。經緊急脾血管栓塞後，症狀大爲改善。後病人情況穩定且正接受門診追蹤治療，追蹤腹部電腦斷層並無新的出血。本文討論的主題爲頸髓受傷病人，發生腹部感覺不良的情況，若有不明原因的內出血，且腹部曾有受傷，就不能忽略腹部器官，尤其是脾破裂的可能性。因爲脾臟受脾被膜保護，但日後會因咳嗽、排痰、打噴嚏、排便等，而引起腹壓增加，使脾被膜再破裂引起內出血。遲發性脾破裂在脊髓損傷病人並不多見，故報告此病例提供臨床參考。

關鍵字

頸髓損傷；遲發性脾破裂

並列摘要

This is a report of a 65-year-old male patient with incomplete spinal cord injury caused by a traffic accident. He was robust prior to this injury. He was hospitalized due to tetraplegia caused by the accident, and did not lose consciousness at the time of injury. A cervical spine MRI was performed and showed cervical spondylosis with a C4-5, C5-6 herniated intervertebral disc. After decompressive surgery, he was transferred to our ward for inpatient rehabilitation, where balance and exercise activities on a mattress were carried out regularly. After 20 days of rehabilitation, acute dyspnea, abdominal distension and unstable vital signs were noted. His hemoglobin dropped from 11.7 mg/dl to 6.4 mg/dl. An emergency abdominal CT was arranged and this showed spleen rupture with a massive hemoperitoneum. Our radiologist performed splenic artery angiography with embolization and a follow up abdominal CT did not show any new bleeding. The patient's condition is currently stable and he is receiving outpatient treatment. This article mainly discusses how a patient with cervical cord injury may have abdominal discomfort related to unknown internal bleeding, particularly after a previous abdominal injury. In these circumstances, a differential diagnosis involving acute injury to the abdomen, especially the spleen, cannot be ignored. The pathophysiology is that the capsule of the spleen should protect the spleen from injury, but an elevation of pressure in the abdomen such as by coughing, sneezing or defecation may result into internal bleeding. Delayed splenic rupture is not common among patients with spinal cord injury and therefore we have described this case in order to share our experiences with this problem.

並列關鍵字

cervical cord injury ； delayed splenic rupture

國際替代計量

頸髓損傷病人出現遲發性脾破裂：病例報告

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