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백종범(Jong Bum Baek),성승훈(Seung Hoon Seong),원달연(Dal Yeon Won),배금석(Keum Seok Bae),김익용(Ik Yong Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.6
Purpose: Spontaneous hemoperitoneum is not a common disease but may cause a fatal outcome. Warfarin is a coumarin anticoagulant, used widely for therapeutic and prophylactic anticoagulation. Although, it is considered a life saving medicine, it is associated with significant adverse effects including intraabdominal bleeding. Literatures about spontaneous hemoperitoneum in patients taking anticoagulants have been reported, but until now there have not been a definite establishment in diagnostic criteria and treatment strategy. Methods: Among 209 patients who were diagnosed hemoperitoneum from Jan 2005 through May 2009, we identified 9 patients with spontaneous hemoperitoneum without any trauma history or solid organ abnormalities. All 9 patients were taking warfarin for various durations. Initially, we evaluated vital signs, laboratory, CT findings, and clinical course, retrospectively. In addition, we analyzed risk factors potentiating the pharmacologic effect of anticoagulants. Results: One of the most prominent features in this study is that all patients showed prolonged international normalized ratio (6.36∼15.11). One patient received an exploratory laparotomy for hemoperitoneum secondary to warfarin, presenting as a localized peritonitis in the right lower quadrant of the abdomen. Mean hospital stay was 15.2 days. Five patients were transfused with packed red blood cells (500∼1,000 ml) and fresh frozen plasma (300∼900 ml). All patients were discharged without any mortality. Conclusion: It is important to identify and confirm the factors that can potentiate the pharmacologic effect of anticoagulants, when acute abdomen is suspected in patients taking anticoagulants. If the patients are hemodynamically stable, they can be treated without surgical intervention.
박일환 ( Il Hwan Park ),오중환 ( Joong Hwan Oh ),성승훈 ( Seung Hoon Seong ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1
Pericardial rupture due to blunt trauma is very rare, but can lead to serious complications. It occurs mainly on the left, is found incidentally during surgery, and is seldom discovered radiologically unless accompanied by cardiac herniation. The following case describes a 53-year-old traffic-accident victim who received emergency pericardial repair and bleeding control via an exploratory thoracotomy and an exploratory laparatomy. The patient was discharged without any complication and remained healthy at six month after injury. (J Korean Soc Traumatol 2009;22:116-118)