创伤后胰腺炎肾损伤后四天,腹膜后大量血肿。

Case Reports in Emergency Medicine Pub Date : 2021-05-07 eCollection Date: 2021-01-01 DOI:10.1155/2021/6693259
Masamichi Kiriyama, Kei Jitsuiki, Ken-Ichi Muramatsu, Hoshiko Furusawa, Soshi Moriya, Youichi Yanagawa
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引用次数: 2

摘要

一名25岁的男子在露营时不小心从悬崖上摔下来,击中了右侧的地面。起初,他几乎不能走路,但由于严重的腰痛,他最终完全不能走路。他没有什么特别的个人或家族病史,只是个应酬酒鬼。到达时,他意识清醒,但处于失血性休克状态。增强计算机断层扫描(CT)显示造影剂外溢从受伤的右肾和大量腹膜后血肿。他接受了大量输血和气管插管,随后进行了肾栓塞。住院第2天生命体征稳定,第3天拔管。在第4天和第5天,血液检查显示淀粉酶水平升高(分别为360和904 IU/L)。第5天增强CT未见严重急性胰腺炎征象。第6天淀粉酶水平最高为1041 IU/L,并逐渐下降,急性胰腺炎的严重程度未恶化。他于第14天出院。在本病例中,创伤后急性胰腺炎的亚急性期可能不是由胰腺的直接损伤引起的,而是由几种致病因素引起的,如休克、腹膜后间隙压力增加或损伤组织或血肿释放炎症介质。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Posttraumatic Pancreatitis Four Days after Renal Injury with Massive Retroperitoneal Hematoma.

A 25-year-old man accidentally fell from a cliff and hit his right flank on the ground while camping. Initially, he was able to barely walk, but he ultimately became unable to walk at all due to severe flank pain. He had no remarkable personal or family history and was a social drinker. Upon arrival, he showed clear consciousness but was in a hemorrhagic shock state. Enhanced computed tomography (CT) revealed extravasation of contrast medium from the injured right kidney with massive retroperitoneal hematoma. He underwent massive blood transfusion and tracheal intubation followed by renal embolization. His vital signs stabilized on hospital day 2, and he was extubated on day 3. On days 4 and 5, a blood examination revealed increased levels of amylase (360 and 904 IU/L, respectively). Enhanced CT on day 5 did not show signs of severe acute pancreatitis. The maximum amylase level was 1041 IU/L on day 6 and decreased day by day without deterioration of the severity of his acute pancreatitis. He was discharged on day 14. The subacute phase of posttraumatic acute pancreatitis in the present case may have been induced not by direct injury to the pancreas but by several causative factors, such as shock, increased pressure of the retroperitoneal space, or the release of inflammatory mediators from injured tissues or hematoma.

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