기침으로 유발된 복직근초 혈종 및 복강내 혈종 1예

A Case of Rectus Sheath Hematoma and Intraperitoneal Hematoma Induced by Cough

  • 정해빈 (가톨릭대학교 의과대학 내과학교실) ;
  • 강현희 (가톨릭대학교 의과대학 내과학교실) ;
  • 임은주 (가톨릭대학교 의과대학 내과학교실) ;
  • 김현경 (가톨릭대학교 의과대학 내과학교실) ;
  • 이수연 (가톨릭대학교 의과대학 내과학교실) ;
  • 맹일호 (가톨릭대학교 의과대학 내과학교실) ;
  • 이지명 (가톨릭대학교 의과대학 내과학교실) ;
  • 장은희 (가톨릭대학교 의과대학 내과학교실) ;
  • 이상학 (가톨릭대학교 의과대학 내과학교실) ;
  • 문화식 (가톨릭대학교 의과대학 내과학교실)
  • Jeong, Hae Bin (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kang, Hyeon Hui (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Im, Eun Joo (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Hyun Gyung (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Su Yeon (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Maeng, Il Ho (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Ji Myoung (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Jang, Eun Hee (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Sang Haak (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Moon, Hwa Sik (Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • 투고 : 2008.05.23
  • 심사 : 2008.06.23
  • 발행 : 2008.09.30

초록

본 증례는 와파린을 복용하던 72세 여자가 기침을 심하게 하던 중 하복부 통증과 압통을 보이는 복부 팽만이 발생하여 복부 전산화단층촬영을 통해 복직근초 혈종을 진단한 경우이다. 복직근초 혈종은 매우 드물지만 항응고제를 복용하는 고령 환자나 분만을 했거나 복부 수술을 받은 경우 등에서 발생할 수 있고, 드물게 기침에 의해서도 발생할 수 있다. 따라서 이런 환자에서 심한 복통이나 복부 종물이 관찰되는 경우 그 가능성을 한 번쯤 생각해보아야 하겠다. 전산화단층촬영은 복직근초 혈종 진단의 특이성과 민감도가 높아 진단에 도움이 되며 대부분은 보존적인 치료만으로 회복되므로 본 질환의 위험인자와 진단방법에 대해 숙지하고 정확한 진단을 하는 것이 무엇보다도 중요하겠다.

Rectus sheath hematoma (RSH) is a rare condition that's caused by a sudden disruption of the deep epigastric vessels or direct damage to the rectus abdominis muscle. This condition is associated with old age, childbirth, abdominal surgery, severe cough, severe sneezing, anticoagulation therapy and/or coagulation disorders. RSH is characterized by abdominal pain and an abdominal mass, so that this is often misdiagnosed as a surgical condition such as appendicitis, intraabdominal abscess, torsion of the ovary and ruptured abdominal aortic aneurysm; this can lead to unnecessary surgery. Thus, we have to be cautious not to miss RSH when a patient with predisposing factors is suffered from abdominal pain and an abdominal mass. We report here on a case of rectus sheath hematoma that was induced by severe cough in a patient who was taking warfarin.

키워드

참고문헌

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