Presentation
45 years old male patient with ESRD undergoing hemo-dialysis pesented with acute abdomen
Patient Data
Note the increased density and thickness of left rectus abdominis muscle due to intramuscular hematoma.
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 herald a surgical or medical emergency. Since the non-traumatic acute abdominal emergencies in this special population bear high mortality and morbidity risks, early diagnosis and treatment are essential with regard to the increase of patients’ longevity and life quality.
Acute abdominal hemorrhage in various locations, including the intraparenchymal, 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 cases, the intramuscular hematoma involved the rectus abdominis muscle. Uremic bleeding is multifactorial and suggested causes include: platelet abnormalities (including a reduction in intracellular ADP and serotonin) and abnormal platelet arachidonic acid metabolism. In addition, oral anticoagulants given to prevent clotting in shunts and arteriovenous fistulas may also contribute. There have been several reports of spontaneous abdominal hemorrhages in end-stage renal failure patients but these have tended to be in haemodialysis patients
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