Acute abdomen in a dialysis patient due to intramuscular haematoma

Case contributed by Dr G Balachandran

Presentation

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

Patient Data

Age: 45
Gender: Male

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

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Case Information

rID: 17606
Case created: 29th Apr 2012
Last edited: 8th Oct 2015
Inclusion in quiz mode: Included

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