Rectus Sheath Hematoma: Two Cases Report

腹直肌血腫：兩病例報告

郭宏達(Horn-Dah Kou) ； 黃英傑(Ying-C. Huang) ； 趙英豪(Ying-Hao Chao) ； 廖志思(Danilo Liao) ； 涂啟文(Chi-Wen Tu)

《Formosan Journal of Surgery》 36卷6期 (2003/12) Pp. 297-300

摘要

腹直肌血腫是一種罕見，卻有可能致命的疾病。該病可自然發生，或是因創傷、接受侵襲性診治、凝血異常而導致。如果沒有高度的懷疑，正確治療的時機很可能磋跎於不必要的檢查、甚至手術，更大的傷害或是死亡就在所難免。在此我們報告兩位腹直肌血腫的病例。患者甲，57歲婦女，因急性右側腹痛就診。抵院時呼吸16，脈搏86，血壓 134 / 84 ，休溫 37 度，右下腹有明顯壓痛。檢驗結果白血球8 , 120，血紅素 13.1，血容比37 %，血小板 203 , 000 ; AST / ALT 46 / 59 , BUN / Crtn 13.0 / 0.9，血糖157，電解質及心肌脾指數均未異常。腹部 CT 檢查，看出右腹直肌腫大且有顯影劑漏出。因持續出血，故給予手術治療。患者乙， 61 歲婦女，因騎腳踏車車禍，摔倒時腹部撞擊方向把手而被送醫。抵院時呼吸 20 ，脈搏 70 ，血壓 143 / 87，休溫36.5 度，右腹瘀青且可摸到腫脹。檢驗結果白血球 n , 130 ，血紅素 12.5 ，血容比 36.4 %，血小板 195 , 000 ; PT 9.8 ” (9.8'') , APTT 26.8 ” ( 37.5”) , AST / ALT44/43 , BUN/Crtn 12.4 / 0.8 , 血糖 156， Na+133 , K + 3.66 ，心肌膽指數未異常。腹部 CT 檢查，見到右前腹壁明顯腫大且有顯影劑漏出。患者住院一般外科，並因持續出血，於翌日接受手術治療。這兩位患者術後均順利康復。腹直肌血腫雖然罕見，急診醫師與外科醫師卻不應該因此而忽略此病。特別是隨著人口老化、抗凝血治療及各種侵襲性醫療日益普遍，該病的發生率將有增而無減。

並列摘要

Rectus sheath hematoma (RSH) is an uncommon but sometimes life-threatening illness. It can occur spontaneously, secondary to trauma, invasive procedure or coagulopathies. Treatments may be delayed due to unnecessary diagnostic procedures or unwanted surgery. Increased morbidity and even mortality may be the result. We described two cases of RSH. Patient 1: A 57 yb woman presented with sudden onset of REQ abdominal pain. Vital signs on arrival were respiration 16 breaths per minute, pulse 86 beats per minute, blood pressure 134/84 mmHg and temperature 37.0°C. Significant REQ abdominal tenderness was found. Laboratory results were WBC 8,120/mm3, Hb 13.1 g/dl, Hct 37%, platelet 203,000/mm3, AST/ALT 46/59 lUlL, BUN/Cre 13.0/0.9 mg/dl, and glucose 157 mgldl. Electrolytes and cardiac markers were unremarkable. Abdomen CT revealed extensive enlargement of the right rectus abdominis muscle with extravasation of contrast medium. Surgical operation was undertaken for intractable pain. Patient 2: A 61 yio woman presented because she crushed her abdomen against the handlebar during a motor vehicle accident. Vital signs on arrival were respiration 20 breaths per minute, pulse 70 beats per minute, blood pressure 143/87 mmflg, and temperature 36.5°C. A soft mass was palpable on her right abdomen with ecchymosis. Laboratory results were WBC 11,130/mm3, Hb 12.5 g/dl, Hct 36.4%, plat 195,000/mm3 PT 9.8”(9.8”), aPTT 26.8”(37.5”), AST/ALT 44/43 IU/L, BUN/Cre 12.4/0.8 mg/dl, glucose 156 mg/dl, Na/K 133/3.66 mEqJL and unremarkable cardiac markers. Abdomen CT revealed a soft-tissue density infiltration over the right anterior abdominal wall with extravasation of contrast medium. She was admitted to the surgical ward and an operation was undertaken on the following day because of progressive hemorrhage. They had uneventful recoveries after surgical operations. Although uncommon, both the emergency physician and the surgeon should be familiar with this disease because the incidence will increase, as elderly patients, anticoagulation therapy and invasive procedures become more commonplace.

並列關鍵字

hematoma ； rectus abdominis sheath