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Acute abdomen in a dialysis patient due to intramuscular haematoma

Case contributed by: Dr G Balachandran

Presentation:

47 years old male patient with ESRD undergoing haemo-dialysis pesented with acute abdomen

Patient Data:

Age: 47

Gender: Male

Race: Asian

From the case: Acute abdomen in a dialysis patient due to intramuscular haematoma

Modality: CT

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non-contrast

Note the increased density and thickness of left rectus abdominis muscle due to intramuscular haematoma.

Case Discussion:

Abdominal pain is one of the most common complaints in ESRD patients. Although most of these complaints arise from self-limiting conditions, abdominal pain might heralda surgical or medical emergency.Since the non-traumatic acute abdominal emergencies in this specialpopulation bears ahighmortality and morbidityrisks, early diagnosisand treatment are essential with regard to increase of patients’ longevity and life quality.

Acute abdominal hemorrhage in various locations, including the intraparencymal, retroperitoneum and abdominal musculature can also lead to a clinical presentation of acute non-traumatic abdominal pain. Spontaneous intraabdominal hemorrhage was observed to be signiﬁcantly more frequently in ESRD patients than in the general population. In most of the cases the intramuscular hematoma involved the rectus abdominismuscle. Uraemic bleeding is multifactorial and suggested causes include: platelet abnormalities (including reduction in intracellular ADP and serotonin) and abnormalplatelet arachidonic acid metabolism. In addition, oral anticoagulants given to prevent clotting in shunts and arteriovenous ﬁstulasmay also contribute. There have been severalreports of spontaneous abdominal haemorrhage inend-stage renal failure patients but these have tended to be in haemodialysis patients