抗凝固療法中の透析患者に発生した腸腰筋血腫の1例

Iliopsoas Hematoma in a Hemodialysis Patient on Anticoagulant Therapy. Case Report

　抗凝固療法中の透析患者が腸腰筋血腫を呈した症例を報告する．63歳の男性で，慢性腎不全で透析を行い，シャント部の人工血管に対し抗凝固剤を服用していた．激しい左大腿痛が出現し当科を受診した．左腸骨窩の腫瘤と左大腿神経麻痺を認め，CT像とMRIで腸腰筋血腫を認めた．血腫除去術を行い，その後に疼痛が軽減し筋力が回復した．原因には血小板機能の異常や抗凝固剤による出血傾向が考えられた．抗凝固療法中の透析患者で誘因なく大腿痛と大腿神経麻痺を呈する例では，腸腰筋血腫を考える必要がある．

　We report a case of iliopsoas hematoma in a hemodialysis patient on anticoagulant therapy. A 63-year-old man who had been on hemodialysis for chronic renal failure and on anticoagulant therapy began to experience severe left thigh pain and symptoms of femoral nerve palsy. A mass was palpated in the left iliac fossa, and a CT scan and MRI scan revealed a iliopsoas hematoma. Decompression surgery was followed by an immediate decrease in pain, and quadriceps muscle strength recovered. Platelet function abnormality and the anticoagulant therapy were thought to be the causes of the hematoma. Iliopsoas hematoma should be considered in hemodialysis patients on anticoagulant therapy who experience severe thigh pain and symptoms of femoral nerve palsy in the absence of trauma.