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DOI: 10.1055/s-2001-16840
Spontan auftretende Bauchwandhämatome
- retrospektive Studie und Literaturübersicht -
Acute occurring hematomas of the abdominal wall - retrospective study and review of the literature -
Publikationsverlauf
Publikationsdatum:
29. August 2001 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200104/lookinside/thumbnails/10.1055-s-2001-16840-1.jpg)
Zusammenfassung.
Spontan auftretende Hämatome der ventralen oder dorsalen Bauchwand sind eine seltene Erkrankung. Dabei hat sich das Patientenkollektiv im Verlauf des letzten Jahrhunderts grundlegend geändert. Ermittelt wurden im Rahmen einer retrospektiven Untersuchung alle operativ versorgten Bauchwandhämatome im Zeitraum von 1974 bis 1999 der chirurgischen Klinik der RWTH Aachen. Insgesamt zeigten sich 49 spontan auftretende Hämatome, davon 31 Rektusscheiden- und 18 retroperitoneale Hämatome. Neben arteriosklerotischen Gefäßveränderungen bestätigt sich v.a. die Antikoagulation mit 69,4% als entscheidender prädisponierender Faktor. Bei ansonsten unspezifischer Symptomatik stellt der akut einsetzende Schmerz das Leitsymptom dar. Das unklare akute Abdomen, die Sigmadivertikulitis sowie der Ileus stellten die häufigsten initialen Fehldiagnosen dar. Insbesondere bei älteren Patienten mit arteriosklerotisch bedingten Begleiterkrankungen sollten Bauchwandhämatome differenzialdiagnostisch im Rahmen der Abklärung eines akuten Abdomens bedacht werden. Die Therapie kann nach interindividuellen Aspekten konservativ, interventionell radiologisch oder operativ erfolgen. Im Rahmen der chirurgischen Therapie sollte das ursächliche Gefäß aufgesucht und ligiert werden. Dies gilt als Rezidivprophylaxe speziell für die durch Blutungen aus den Vasa epigastricae inferiores verursachten Rektusscheidenhämatomen.
Acute occurring hematomas of the abdominal wall - retrospective study and review of the literature -
Spontaneously occurring hematomas of the ventral or dorsal abdominal wall are rare. Whereby the patient collective in the course of the final century changed fundamentally. In this retrospective study spontaneously hematomas were recorded in the period of 1974 to 1999, which had an operative intervention at the Surgical Clinic of RWTH Aachen. Alltogether 49 hematomas were collected, 31 inside rectus muscle sheath and 18 retroperitoneal hematomas. Apart arteriosclerotic vessel diseases anticoagulant therapy could confirmed as predominant factor in 69,4%. With otherwise non-specific symptomatology the acutely appearing pain represents the most frequent symptom. The unclear acute abdomen, sigmadiverticulitis and intestinal obstruction have been the most frequent initial wrong diagnoses. Nowadays spontaneously occurring hematomas of the abdominal wall should be considered in particular for differential diagnosis in the context of the clarification of an acute abdomen of older patients with arteriosclerotic caused diseases. The choice of therapy, conservative treatment, radiological intervention or surgical intervention, has to result under consideration of inter-individual aspects. Ligation of the causel vessel, if possible, is the basic element of the surgical therapy. This has to be considered as prophylaxis for a relapse particularly for hematomas of the rectus sheath caused by bleedings of the inferior epigastric vessels.
Schlüsselwörter:
Spontane Hämatome - Rektusscheide - Retroperitoneum - Antikoagulation
Key words:
Spontaneous hematoma - Rectus sheath - Retroperitoneum - Anticougulation
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Dr. med. Karsten Junge
Chirurgische Universitätsklinik und Poliklinik
RWTH Aachen
Pauwelsstr. 30
52057 Aachen
eMail: mail@kjunge.de