Ulus Travma Acil Cerrahi Derg. 2011; 17(2): 183-185 | DOI: 10.5505/tjtes.2011.48615

Akut abdominal kompartman sendromuna yol açan gecikmiþ retroperitoneal kanama: Olgu sunumu

Fikri M. Abu-zidan¹, Ali Jawas¹, Mustafa Boraie², Misbah U. Ahmed^3
1Birleþik Arap Emirlikleri Týp Fakültesi, Travma Grubu, Al-ain, Birleþik Arap Emirlikleri
²Al-ain Hastanesi Acil Týp Kliniði, Al-ain, Birleþik Arap Emirlikleri
³Al-ain Hastanesi, Radyoloji Bölümü, Al-ain, Birleþik Arap Emirlikleri

Retroperitoneal kanamaya baðlý gecikmiþ akut abdominal kompartman sendromu (AKS) nadir görülür. Burada, böyle nadir bir olgunun klinik tedavisi sunuldu. 12 metre yükseklikten düþen 46 yaþýndaki bir erkek, Al-Ain Hastanesine yatýrýldý. Hasta hemodinamik olarak stabildi. Fiziksel incelemesinde, karýn yumuþaktý, þiþkin deðildi. Yatýrýlma sýrasýnda gerçekleþtirilen karýn bilgisayarlý tomografisi (BT) bulgularý normaldi, 7. günde hasta, enteral beslemeyi tolere etti, 15. günde hasta aniden hipotansif hale geldi. BT’sinde aktif kanamayý gösteren kontrast renkle birlikte inferior vena kavaya basý yapan büyük bir retroperitoneal hematom belirlendi. Karný, þiþkin ve gergindi. Hastada
respiratuvar yetersizlik ve ciddi asidoz geliþmiþ, havayolu basýncý artmýþ ve idrar çýkýþý azalmýþtý. AKS tanýsý konuldu. Laparotomiden hemen sonra, hemodinamik ve respiratuvar
fonksiyonda dramatik düzelme oldu. Retroperitoneal hematoma iliþkin araþtýrma, aktif olarak kanayan baðlanmýþ ileokolik bir damar olduðunu gösterdi. Karýn, iki katmanlý
Steri-Drape arasýna yerleþtirilen IV serum fizyolojik torbalarý kullanýlarak geçici olarak kapatýldý. Karýn, 6. günde primer olarak kapatýldý. Hasta, 50. günde evine taburcu
edildi. Yaþamý tehdit edici retroperitoneal kanama, AKS’ye yol açan travmadan iki hafta sonra aniden oluþabilir.

Anahtar Kelimeler: Abdominal kompartman sendromu, kanama; retroperitoneal

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Delayed retroperitoneal bleeding causing acute abdominal compartment syndrome: case report

Fikri M. Abu-zidan¹, Ali Jawas¹, Mustafa Boraie², Misbah U. Ahmed^3
1Trauma Group, Faculty Of Medicine, Uae University, Al-ain, United Arab Emirates
²Department of Critical Care, Al-Ain Hospital, Al-Ain, United Arab Emirates
³Department Of Radiology, Al-ain Hospital, Al-ain, United Arab Emirates

Delayed acute abdominal compartment syndrome (ACS) due to retroperitoneal bleeding is rare. Herein, we report the clinical management of such a rare case. A 46-year-old male who fell from a height of 12 meters was admitted to Al-Ain Hospital. He was hemodynamically stable. His abdomen was soft and not distended. Abdominal computed tomography (CT) was normal on admission. On day 7, the patient tolerated enteral feeding. On day 15, he became suddenly hypotensive. CT of the abdomen showed a large retroperitoneal hematoma compressing the inferior vena cava (IVC) associated
with contrast blush indicating active bleeding. The abdomen became distended and tense. The patient developed respiratory failure and severe acidosis, increased airway
pressure and reduced urine output. A clinical diagnosis of ACS was made. There was dramatic improvement in the hemodynamic and respiratory function directly after laparotomy. Exploration of the retroperitoneal hematoma showed an actively bleeding ligated ileocolic vessel. The abdomen was temporarily closed using saline IV bags sandwiched between two layers of Steri-Drape. The abdomen was closed primarily on day 6. The patient was discharged home on day 50. Life-threatening delayed retroperitoneal bleeding may occur suddenly two weeks after trauma causing ACS.

Keywords: Abdominal compartment syndrome, bleeding; retroperitoneal

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