항혈소판제 복용 중 발생한 구불결장의 자발성 장벽내 혈종 1예
Spontaneous Intramural Hematoma of the Sigmoid Colon Caused by Anti-platelet Agents
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초록
71세 남자가 1일 전부터 발생한 급성 복통과 혈변으로 내원하였다. 환자의 과거력에서 수술받은 적은 없었으며 아스피린과 클로피도그렐을 복용 중이었다. 구불결장경검사에서 청색의 융기 병변이 관찰되었으며 점막하 출혈이 동반된 장벽내 혈종이 구불결장에서 관찰되었고, 전산화단층촬영에서 근위 구불결장의 장벽이 저음영으로 두꺼워져 보여 구불결장의 자발성 장벽내 혈종으로 진단하였다. 환자는 20일 동안 아스피린과 클로피도그렐을 중지하고 보존 치료를 받고 호전되었다. 이번 증례는 이전에 보고되지 않았던 항혈소판제의 처방을 받은 환자에서 발생한 비외상성 장벽내 혈종을 경험하여 보고한다.
Abstract
A 71-year-old man presented at the emergency department with an acute onset of hematochezia and abdominal pain that had developed 1 day previously. He had no history of surgery and was taking aspirin (100 mg) and clopidogrel (75 mg). CT revealed a short segmental concentric lower density bowel wall thickening at the proximal sigmoid colon. Sigmoidoscopy showed blue-colored elevated lesions and ruptured intramural hematomas with submucosal bleeding in the sigmoid colon. These findings correspond to intramural hematomas of the sigmoid colon. His symptoms were reduced with conservative treatment stopping aspirin and clopidogrel for 20 days. Here we report a case of non-traumatic intramural hematoma of the colon in a patient receiving dual antiplatelet agents. This had never been reported.
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