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혈복강 수술 환자에게서 발생한 지연성 외상성 뇌실질내 출혈
김소현 ( So Hyun Kim ),배금석 ( Keum Seok Bae ),변진수 ( Jinsu Pyen ),김종연 ( Jong Yun Kim ),조성민 ( Sung Min Cho ),노하니 ( Hany Noh ),황금 ( Kum Whang ),오지웅 ( Ji Woong Oh ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3
Delayed traumatic intracerebral hemorrhage (DT-ICH) is a rare event in head trauma patients. However, it develops unexpectedly and results in very severe brain damage. Thus, close monitoring of the neurologic status is needed for every trauma patient. Sometimes, however, neurologic monitoring cannot be done because of sedation, especially in cases of abdominal surgery. In this case report, we describe the case of a 37-yr-old, male patients who had hemoperitoneum because of spleen and renal injury. At the initial operation, massive bleeding was found, so gauze-packing surgery was done first. After the first operation, we sedated the patient for about two days, after which the packed gauze was removed, and the abdominal wound was closed. Immediately after the second operation, we found pupil dilation. Emergent CT was performed. The CT revealed DT-ICH with severe brain edema and midline shifting. However, the patient condition deteriorated progressively despite emergency operation, he expired 2 days after hematoma evacuation.