© 2003 by BMJ Publishing Group & European League Against Rheumatism
LESSON OF THE MONTH
A rare case of shock
Series editor: Anthony D Woolf
1 Department of Surgery, Derby City General Hospital, Derby DE22 3NE, UK
2 Clinical Immunology Unit, Queens Medical Centre, Nottingham NG7 2UH, UK
Correspondence to:
Correspondence to:
Dr E Drewe;
liz.drewe@nottingham.ac.uk
Accepted 12 December 2002
Keywords: fibromuscular dysplasia
Abbreviations: FMD, fibromuscular dysplasia; MRA, magnetic resonance angiography; PAN, polyarteritis nodosa; SMA, superior mesenteric artery
| The first 150 words of the full text of this article appear below. |
A 48 year old non-smoking women presented with a six hour history of colicky right upper quadrant pain radiating to the back preceded by an episode of syncope. Past history included hyperthyroidism treated by partial thyroidectomy.
Initial examination showed mild right upper quadrant tenderness. Investigations demonstrated a normocytic anaemia (haemoglobin 92 g/l), white cell count 15.3xl09/l, with normal liver function tests and amylase. Twelve hours later she developed shock associated with a distending abdomen.
Emergency laparotomy showed a haemoperitoneum and huge retroperitoneal haematoma with catastrophic bleeding from the duodenojejunal region requiring 13 units of blood and 8 litres of colloid and crystalloid. Haemostasis was achieved with aortic cross suturing around a branch of the superior mesenteric artery (SMA) and packing the peritoneum. Packs were removed 24 hours later without complication.
A postoperative mesenteric angiogram delineated multiple small aneurysms in the gastroduodenal artery and its pancreatic branches, hepatic
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