An 80-year-old woman suffering from severe pump failure and chronic atrial fibrillation (AF) presented to the emergency department (ED) with weakness and abdominal pain. She had been on oral anticoagulants due to prosthetic mechanical valves, and two weeks before presentation she begun therapy with nadroparin 100 U/kg twice a day for pacemaker-implantable cardio-verter (PMK-ICD) replacement. Upon examination cutis was pale and her abdomen appeared tender over the right Quadrants with a palpable mass in this area. Her blood pressure was 70/40 mmHg and laboratory examinations revealed hemoglobin (Hb) 9 g/dL and creatinine 5,4 mg/dL (clearance 10 mL/min). She had no history of renal failure. Fluids and red blood cells were immediately given and a computed tomography (CT) scan showed a 7 x 10 cm rectus sheath hematoma (Fig. la). Angiographic selective embolization was performed, but the patient's general condition progressively worsened. Although an aggressive therapy with fluids, red blood cells, inotropic drugs, high dose diuretics, bicarbonate and dialysis was administered, she died after a few days due to cardiogenic shock.
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机译：一名患有严重泵功能衰竭和慢性心房纤颤（AF）的80岁妇女因虚弱和腹痛而被送往急诊科（ED）。由于使用了人工瓣膜，她一直在接受口服抗凝剂治疗，在就诊前两个星期，她开始每天两次两次以100 U / kg的萘达普林进行治疗，以更换起搏器可植入的心律转换（PMK-ICD）。经检查，皮肤角质苍白，腹部在右侧象限上方出现触痛，肿块明显。她的血压为70/40 mmHg，实验室检查发现血红蛋白（Hb）为9 g / dL，肌酐为5,4 mg / dL（清除率10 mL / min）。她没有肾脏衰竭的病史。立即给予体液和红细胞，计算机断层扫描（CT）扫描显示有7 x 10 cm的直肌鞘血肿（图1a）。进行了血管造影术选择性栓塞术，但患者的一般情况逐渐恶化。尽管使用了液体，红细胞，正性肌力药物，大剂量利尿剂，碳酸氢盐和透析等积极疗法，但由于心源性休克，她在几天后死亡。
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