移植技術と研究

The Real Intraoperatve Diagnosis of a Patient with Lipothymia and Arterial Hypotension

Abstract

Manuela Stoicescu

Objectives: The main objectives of this clinical case presentation was to determine the real cause of a 50 year patient that presented into emergency service for an episode of lipothymia and arterial hypotension (BP=60/40 mmHg).

Description of the methods: I am presenting the clinical case of a 50 year old patient that come at the emergency service for an episode of lipothymia and arterial hypotension (BP=60/40 mmHg). The objective examination revealed: pale skin and mucous, tachycardia (HR=105/min), normal vesicular sound, BP=60/40 mmHg. Palpation of the abdomen was insensitive, soft, elastic, participating at the respiratory movements. No presented rebound tenderness (without clinical signs of peritoneal irritation). Normal rectal touch–brown aspect of feces without pain during the maneuver. The paraclinical investigations have shown: EKG sinus tahycardia (105 bates/minutes), ESR=24/42, fibrinogen=580 mg/dl, Hb=11 g/dl, Ht=42%, erythrocytes=4 500000 per cubic millimeter, white blood cell=5200 per cubic millimeter, platelets=200000 per cubic millimeter, TGO=12 UI/l, TGP=10 UI/l TroponinT=0,05 μg/L, CPKMB=10 mcg/L. Echocardiography was normal. In this stage, with a diagnosis of lipothymia and arterial hypotension a treatment with injectomat with dopamine with a rhythm of administration 0.2 ml per hour was initiated, but the value of blod pressure decreased:BP=50/30 mmHg. An emergency abdominal ultrasaound was performed, which reveals an increased quantity of intraabdominal fluid, which does not allow the visualization of the internal organs. A paracentesis was performed and surprisingly - the liquid was fresh blood, so the patient had hemoperitoneum. The patient was transferred in the General Surgery Department for emergency laparotomy. The real diagnosis was: broken and bleeding right ovarian tumor with hemoperitoneum. A haemoperitoneum suction drainage was performed and a right ovarian resection, with favorable evolution and the saving of the patient’s life.

Summary of the results: The onset of this clinical case was surprisingly through with a vital risk complication, the apparition of the hemoperitoneum, which clinically it manifested through lypothymia and hypotension (BP=60/40 mmHg).

Conclusions: Principal particularity of this clinical case report was the sudden onset with a vital risk complicationhemoperitoneum and a hemorrhagic shock tendency. The hemoperitoneum is the single situation of acute surgical abdomen, in wich the clinical signs of peritoneal irritation is possible do not appear.