Antikoagülan Kullanımına Bağlı Akut Karın Ağrısının Nadir Bir Nedeni: Spontan Rektus Kılıf Hematomu

Rektus kılıf hematomu, rektus abdominis kasına kanama veya direkt kas yırtılması sonucu olabilmekle beraber, travmatik olmayan spontan rektus kas hematomu nadir görülen bir klinik tablodur. Bu olgu sunumunda, kalp kapak replasmanı cerrahisi sonrası antikoagülasyon amaçlı varfarin sodyum başlanan bir hastada meydana gelen spontan rektus kas hematomu olgusu sunulmaktadır. 41 yaşında kadın hasta 2 gündür devam eden öksürük sonucu başlayan karın ağrısı şikayetleri ile hastanemize başvurdu. Hasta kalp kapak replasmanı sonrası antikoagülasyon amaçlı varfarin sodyum tedavisi almaktaydı. Hastanın fizik muayenesinde batın sol alt kadranda ekimoz, şişkinlik ve sertlik mevcuttu. Ayrıca şişkin kısımda defans vardı. Hastanın öyküsünde herhangi bir karın travması öyküsü yoktu. Abdominal ultrasonografide ve bilgisayarlı tomografide taramasında rektus kılıf hematomu tespit edildi. Hasta spontan rektus kas hematomu tanısı ile genel cerrahi servisine yatırıldı. Varfarin sodyum, intravenöz K vitamini kullanılarak antagonize edildi. Başvurusunun 10. gününde hemoglobin değeri stabil olan, vital bulguları stabil olan hasta komplikasyonsuz bir şekilde taburcu edildi. Hastaneye karın ağrısı ile başvuran, travma öyküsü olmayan ve varfarin sodyum kullanan hastalarda spontan rektus kılıf hematomu olabileceği akılda bulundurulmalıdır.

Anahtar Kelimeler:

Abdominal rektus kası, Hematomlar, Karın ağrısı, Varfarin sodyum.

A Rare Cause of Acute Abdominal Pain due to Anticoagulant Use: Spontaneous Rectus Sheath Hematoma

Although rectus sheath hematoma may be the result of bleeding into the rectus abdominis muscle or direct muscle rupture, non-traumatic spontaneous rectus muscle hematoma is a rare clinical presentation. In this case report, a case of spontaneous rectus muscle hematoma occurring in a patient who was initiated warfarin sodium for anticoagulation purposes after heart valve replacement surgery was presented. A 41-year-old female patient was admitted to our hospital with complaints of abdominal pain that started as a result of cough that had been going on for 2 days. The patient was receiving warfarin sodium treatment for anticoagulation purposes after heart valve replacement. On physical examination, there were ecchymosis, swelling and stiffness in the left lower quadrant of the abdomen. There was also defense in the bulging part. There was no history of abdominal trauma in the patient’s history. Rectus sheath hematoma was detected in abdominal ultrasonography and computed tomography scan. The patient was admitted to the general surgery service with the diagnosis of spontaneous rectus muscle hematoma. Warfarin sodium was antagonized using intravenous vitamin K. On the 10th day of admission, the patient’s hemoglobin level was stable and his vital signs were stable and she was discharged without any complications. It should be kept in mind that spontaneous rectus sheath hematoma may occur in patients who present to the hospital with abdominal pain, have no history of trauma, and use warfarin sodium.

Keywords:

Abdominal rectus muscle, Hematomas, Abdominal pain, Warfarin sodium,

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