■腹内血肿可以通过血管栓塞治疗,外科引流,或根据患者因素经皮引流,基础病理学,血肿的大小和稳定性。在过去的几十年里,使用纤维蛋白溶解剂在胸膜腔内积液的经皮管理方面取得了进展。然而,在纤溶辅助经皮穿刺引流术的帮助下,腹腔内血肿的解决尚未像胸膜内纤溶药物那样广泛研究。我们的病例提出了一种情况,即使用纤维蛋白溶解剂有效地进行腹腔积液引流,从而避免了对有多次腹部手术史的患者进行手术干预。从本质上讲,此病例报告可以帮助指导未来的研究,以探索具有多次腹部手术史的患者的非手术管理选择。
■在本报告中,我们介绍了一名51岁的女性食管裂孔疝修补术后空肠造口管(J管)换管并发腹壁外血肿,她的J管周围持续腹痛和渗漏。由于她过去的多次腹部手术史,包括多次食管裂孔疝修补术,Roux-en-Y远端食管切除术,并修改了所述Roux-en-Y并发伤口开裂,手术引流被推迟,有利于通过导管进行纤溶给药试验.为此,我们采用了第二次多中心胸膜内脓毒症试验(MIST2)使用的纤溶给药方案。
■按照MIST2方案使用组织纤溶酶原激活剂(t-PA)和脱氧核糖核酸酶(DNase)可以安全地复制腹内壁血肿,并导致血肿在1周内几乎完全消退。患者最终出院,无并发症。此病例强调了纤维蛋白溶解剂在腹内血肿非手术治疗中的安全有效使用。
UNASSIGNED: Intrabdominal hematoma can be managed with angioembolization, surgical drainage, or percutaneous drainage depending on the patient factors, underlying pathology, and size and stability of hematoma. During the past decades, advancements have been made in the percutaneous management of intrapleural fluid collections using fibrinolytics. However, intrabdominal hematoma resolution with the help of
fibrinolytic-assisted percutaneous drainage has not been as widely studied as intrapleural fibrinolytics. Our case presents a scenario where effective percutaneous drainage of abdominal fluid collection using fibrinolytics avoided an operative intervention in a patient with a history of multiple abdominal surgeries. This case report in essence can help navigate future studies into exploring non-operative management options in patients with a history of multiple abdominal surgeries.
UNASSIGNED: In this report, we present a 51-year-old female status post hiatal hernia repair with jejunostomy tube (J-tube) exchange complicated by walled off intraabdominal hematoma who presented with persistent abdominal pain and leakage around her J-tube. Due to her past history of multiple abdominal surgeries including multiple hiatal hernia repairs, distal esophagectomy with Roux-en-Y, and revision of the said Roux-en-Y complicated by wound dehiscence, surgical drainage was deferred in favor of trialing
fibrinolytic administration via catheters. For this purpose, we employed the protocol for
fibrinolytic administration used by the Second Multicenter Intrapleural Sepsis Trial (MIST2).
UNASSIGNED: Use of tissue plasminogen activator (t-PA) and deoxyribonuclease (DNase) as per MIST2 protocol was safely replicated for intrabdominal walled off hematoma and resulted in a near complete resolution of the hematoma in 1 week. The patient was eventually discharged with no complications. This case highlights safe and efficacious use of fibrinolytics for non-operative management of intrabdominal hematomas.