The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

A Case of Rectus Sheath Hematoma and Pelvic Cavity Hematoma Induced by Dalteparin Injection

저분자량 헤파린 피하주사로 유발된 복직근초 혈종 및 골반강내 혈종 1예

  • Ryu, Sung Woo (Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Lee, Min-Young (Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Ham, Nam Seok (Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Kyoung Ha (Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Lee, Nam Su (Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Won, Jong Ho (Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Park, Hee Sook (Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University College of Medicine)
  • 류성우 (순천향대학교 의과대학 내과학교실, 종양혈액내과) ;
  • 이민영 (순천향대학교 의과대학 내과학교실, 종양혈액내과) ;
  • 함남석 (순천향대학교 의과대학 내과학교실, 종양혈액내과) ;
  • 김경하 (순천향대학교 의과대학 내과학교실, 종양혈액내과) ;
  • 이남수 (순천향대학교 의과대학 내과학교실, 종양혈액내과) ;
  • 원종호 (순천향대학교 의과대학 내과학교실, 종양혈액내과) ;
  • 박희숙 (순천향대학교 의과대학 내과학교실, 종양혈액내과)
  • Received : 2013.03.14
  • Accepted : 2013.04.18
  • Published : 2013.11.01
⟨ Previous Next ⟩

Abstract

Rectus sheath hematoma (RSH) is an uncommon condition caused by hemorrhage into the rectus sheath. RSH is characterized by abdominal pain and an abdominal mass. This condition is associated with old age, childbirth, abdominal surgery, severe coughing, severe sneezing, anticoagulation therapy, and/or coagulation disorders. We report herein a case of RSH and pelvic cavity hematoma that was induced by dalteparin injection in a 77-year-old woman with pulmonary embolism and deep vein thrombosis, and who was successfully treated by conservative management.

본 증례는 항응고 치료를 시행하는 과정에서 물리적인 혈관 손상으로 인한 복직근초 혈종과 골반강 내 혈종이 함께 발생한 경우이다. 복직근초 혈종은 매우 드물게 발생하지만 위험인자가 있는 환자들에게서 심한 복통이나 복부 종물이 관찰되는 경우 고려해보아야 한다. 저자들은 이에 대하여 경피적 배액술을 통한 치료를 시행한 증례를 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore) 2006;85:105-110. https://doi.org/10.1097/01.md.0000216818.13067.5a
  2. Yun HR, Yoo KD, Kim YJ, Yoo TS, Song SY, Jun JB. Rectus sheath hematoma complicated by rectus abdominus myonecrosis in a patient with rheumatoid arthritis. J Korean Rheum Assoc 2007;14:91-95. https://doi.org/10.4078/jkra.2007.14.1.91
  3. Kayrak M, Bacaksiz A, Yazici M. Is enoxaparin injection from the abdominal wall safe in elderly people? a fatal case of rectus sheath hematoma. Can Fam Physician 2008;54: 1246-1248.
  4. Andersson LO, Barrowcliffe TW, Holmer E, Johnson EA, Sims GE. Anticoagulant properties of heparin fractionated by affinity chromatography on matrix-bound antithrombin iii and by gel filtration. Thromb Res 1976;9:575-583. https://doi.org/10.1016/0049-3848(76)90105-5
  5. Young E, Wells P, Holloway S, Weitz J, Hirsh J. Ex-vivo and in-vitro evidence that low molecular weight heparins exhibit less binding to plasma proteins than unfractionated heparin. Thromb Haemost 1994;71:300-304.
  6. Donaldson J, Knowles CH, Clark SK, Renfrew I, Lobo MD. Rectus sheath haematoma associated with low molecular weight heparin: a case series. Ann R Coll Surg Engl 2007; 89:309-312. https://doi.org/10.1308/003588407X179152
  7. Charles FL, Lora LA, Morton PG, Leonard LL. Drug information handbook. 15th ed. Hudson: Lexi-comp Inc., 2007.
  8. Moore KL. Clinically oriented anatomy. 3rd ed. Baltimore: Williams & Wilkins. 1992.
  9. Jeong HB, Kang HH, Im EJ, et al. A case of rectus sheath hematoma and intraperitoneal hematoma induced by cough. Tuberc Respir Dis 2008;65:212-215. https://doi.org/10.4046/trd.2008.65.3.212
  10. Fukuda T, Sakamoto I, Kohzaki S, et al. Spontaneous rectus sheath hematomas: clinical and radiological features. Abdom Imaging 1996;21:58-61. https://doi.org/10.1007/s002619900010