신부전 환자에서 치료 내시경술 후 발생한 십이지장 벽내 혈종과 혈복강 1예
A Case of Duodenal Intramural Hematoma and Hemoperitoneum after Therapeutic Endoscopy in a Patient with Chronic Renal Failure
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십이지장 벽내 혈종의 원인은 복부에 외상이 가해졌을 때 가장 흔하며 혈액 응고 장애 환자나 항응고제 사용 환자 그리고 내시경적 치료 후에 드물게 발생할 수 있다. 십이지장 벽내 혈종의 증상은 복통, 구토, 발열, 혈변 등이 있고 장폐색이나 복막염, 췌장염 등의 합병증을 동반하기도 한다. 진단은 전산화 단층 촬영 및 복부 초음파 등으로 하며 장폐색이나 복막염의 합병증이 없고 환자의 전신 상태가 양호한 경우 보존적 치료만으로 대부분 회복된다. 저자들은 토혈을 주소로 내원한 말기 신부전 환자에서 십이지장 궤양의 내시경적 지혈술 후 발생한 십이지장 벽내 혈종과 혈복강이 보존적 치료로 호전된 1예를 경험하였기에 문헌 고찰과 함께 보고한다.
Abstract
Duodenal intramural hematoma is mostly caused by blunt abdominal trauma. It is also less commonly reported as a complication of anticoagulation therapy or as a blood dyscrasia, and as a complication of diagnostic/ therapeutic endoscopy. The presentation of these patients is abdominal pain, vomiting, fever and hematochezia, and this is rarely accompanied with intestinal obstruction, severe pancreatitis and acute peritonitis as its complications. The diagnosis is made clear by performing abdominal ultrasonography and abdominal computed tomography. We reported here on one case of intramural duodenal hematoma and hemoperitoneum after performing endoscopic hemostasis in a chronic renal failure patient who was on maintenance hemodialysis. (Korean J Gastrointest Endosc 2007;34:269-273)
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