A 19 year old male patient, because of the "2 hours of unconsciousness with sudden abdominal pain, 40 minutes to the emergency department of
A 19 year old male patient, because of the "2 hours of unconsciousness with sudden abdominal pain, 40 minutes to the emergency department of our hospital, the patient body health; physical examination: blood pressure, heart rate of 124 40/15mmHg / min, breathing 24 times / min, confusion, severe anemia, abdominal muscle tension, weak bowel sounds, shifting dullness positive; abdominal puncture uncoagulable blood; hemoglobin 56g/L; abdominal ultrasound: Pancreatic spleen kidney showed no abnormalities, a large amount of liquid in the abdominal cavity. Diagnosis: 1 hemorrhagic shock; 2 intra-abdominal hemorrhage of unknown causes: rupture of abdominal aortic aneurysm? Abdominal hemangioma rupture bleeding? Emergency laparotomy under general anesthesia.
Intraoperative findings: the median incision open the peritoneum, ejected a lot of red blood, aspirator and gauze pad absorb blood, attract the blood by autologous blood salvage treatment, peripheral intravenous infusion, check: see liver, gallbladder and pancreas, spleen, stomach, colon, abdominal aorta the small intestine, and no pelvic bleeding changes, abdominal peritoneum has a lot of blood, separating off the gastrocolic ligament see the tail of the pancreas on the edge of the splenic artery at the rip, a jet of bleeding, with finger pressing inside of the splenic artery and vein, variable bleeding racemose, and multiple fistula between the splenic artery and splenic vein among them, the fusion showed tumor like, the splenic artery and vein from the roots of complete occlusion after hemorrhage control. Intraoperative diagnosis of splenic arteriovenous malformations, arteriovenous malformations of splenic veins. The splenic artery and vein ligation, splenectomy. Smooth operation. Postoperative patients recovered well and recovered.
Discussion: splenic arteriovenous fistula is rare in clinic, and mostly dry arteriovenous fistula, most patients with hypersplenism symptoms; aneurysmal arteriovenous fistula between the arteriovenous branch of small, local vessel with aneurysmal dilatation, blood flow less, no noise and tremor. Therefore, the existence of a large number of patients with arteriovenous shunt and splenic vein dilation, hyperemia, swelling or spleen tissue hyperplasia, hyperthyroidism and other pathological changes, predominate; tumor in slowly increasing spontaneous rupture process, cause bleeding. If there is no history of abdominal bleeding, should be carefully checked, alert the possibility of such bleeding.
Premature Ejaculation,Tumour,Hypertension,Depression,Tumour,Andrology Diseases,Tumour,Arthritis,Pain,Deaf,。 Cure999
Cure999 @ 2018