Kronik Böbrek Yetmezliği Olan Hastada Akut Karın Ağrısı ve Parapleji: Leriche Sendromu

Yıl 2013, Cilt: 4 Sayı: 4, 154 - 157, 01.10.2013

Aytekin Bayır İbrahim Arzıman Ümit Kaldırım Ali Osman Yıldırım Mehmet Ali Şahin Yalçın Bozkurt

Öz

Leriche’s syndrome represents an arterial occlusion of the aortic bifurcation with ischaemic symptoms of both legs. A case of Leriche’s syndrome as a complication of end stage renal failure has not yet been reported in the litarature. A 50-year-old woman was taken into the emergency service with severe abdominal and leg pain, loss of movement of both legs, and dyspnoea. On physical examination, there was abdominal tenderness, coldness and pallor of both legs, and pulselessness of the upper and lower extremities. No flow was seen in either femoral artery with superficial ultrasonography probe in the emergency department. Dynamic thorax and abdominal computed tomography was planned and total occlusion of the infrarenal level of the abdominal aorta was detected. Within the first hour of the diagnosis of acute thrombosis of the aorta bifurcation, bilateral femoral embolectomy was performed by the Cardiavascular Surgery Clinic. After 1 week, the paitent was discharged without any complication. Chronic renal disease patients, especially those referred to the emergency department with acute complaints, must be evaluated carefully and quickly, primarily for cardiovascular diseases. Principally, infrarenal aortic occlusion must be considered and femoral pulses must be examined in the differential diagnosis for patients presenting with paraplegia and severe pain.

Anahtar Kelimeler

Leriche sendromu, kronik böbrek yetmezliği, parapleji, femoral nabız

Acute Abdominal Pain and Paraplegia in a Patient with Chronic Renal Disease: Leriche's Syndrome

Öz

Leriche’s syndrome represents an arterial occlusion of the aortic bifurcation with ischaemic symptoms of both legs. A case of Leriche’s syndrome as a complication of end stage renal failure has not yet been reported in the litarature. A 50-year-old woman was taken into the emergency service with severe abdominal and leg pain, loss of movement of both legs, and dyspnoea. On physical examination, there was abdominal tenderness, coldness and pallor of both legs, and pulselessness of the upper and lower extremities. No flow was seen in either femoral artery with superficial ultrasonography probe in the emergency department. Dynamic thorax and abdominal computed tomography was planned and total occlusion of the infrarenal level of the abdominal aorta was detected. Within the first hour of the diagnosis of acute thrombosis of the aorta bifurcation, bilateral femoral embolectomy was performed by the Cardiavascular Surgery Clinic. After 1 week, the paitent was discharged without any complication. Chronic renal disease patients, especially those referred to the emergency department with acute complaints, must be evaluated carefully and quickly, primarily for cardiovascular diseases. Principally, infrarenal aortic occlusion must be considered and femoral pulses must be examined in the differential diagnosis for patients presenting with paraplegia and severe pain

Anahtar Kelimeler

Leriche’s syndrome, chronic renal disease, paraplegia, femoral pulse

Kaynakça

• Malyszko J, Malyszko JS, Mysliwiec M. Comparison of hemostatic distur- bances between patients on CAPD and patients on hemodialysis. Perit Dial Int 2001; 21: 158-65.
• Sönmez ÖU. Hemodiyaliz tedavisi gören diyabetik ve nondiyabetik has- talarda fibrinolitik sistem aktivitesinin araştırılması: Uzmanlık Tezi, 2008; Haseki Eğitim ve Araştırma Hastanesi, İstanbul.
• Hryszko T, Malyszko J, Malyszko JS, Brzosko S, Mysliwiec M. Patients on peritoneal dialysis but not on hemodialysis have elevated concentra- tion and activity thrombin activable fibrinolysis inhibitor. Thromb Res 2001; 104: 233-8. [CrossRef]
• Zankl AR, Blessing E, Volz HC, Krumsdorf U, Katus HA, Andrassy M. Neu- rological symptoms in acute Leriche’s syndrom. Clin Res Cardiol 2010; 99: 459-62. [CrossRef]
• Elbardissi AW, Dearani JA, Daly RC, Mullany CJ, Orszulak TA, Puga FJ, et al. Embolic potential of cardiac tumors and outcome after resection: a case-control study. Stroke 2009; 40: 156-62. [CrossRef] 6. Lee WJ, Cheng YZ, Lin HJ. Leriche syndrome. Int J Emerg Med 2008; 1: 223. [CrossRef]
• Triantafyllopoulos GK, Athanassacopoulos M, Maltezos C, Pneumaticos SG. Acute infrarenal aortic thrombosis presenting with flaccid paraple- gia. Spine 2011; 36: 1042-5. [CrossRef]
• Surowiec SM, Isiklar H, Sreeram S, Weiss VJ, Lumsden AB. Acute occlusi- on of the abdominal aorta. Am J Surg 1998; 176: 193-7. [CrossRef]
• El-Kayali A, Al-Salman M. Unusual presentation of acute bilateral lower limb ischemia: Thrombosis of abdominal aortic aneurysm-case report . Annals of Saudi Medicine 2001; 21: 5-6.
• Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco MV, et al. Athe- rosclerotic cardiovascular disease risk in chronic hemodialysis patients. Kidney Int 2000; 58: 353-62. [CrossRef]
• Kobayashi M, Yorioka N, Yamakido M. Hipercoagulability and secondary hyperfibrinolysis may be related to abnormal lipid metabolism in pati- ents treated with continuous ambulatory peritoneal dialysis. Nephron 1997; 76: 56-61. [CrossRef]
• Kim KJ, Yang WS, Kim SB, Lee SK, Park JS. Fibrinogen and fibrinolytic activity in CAPD patients with atherosclerosis and it’s correlation with serum albumin. Perit Dial Int 1997; 17: 157-61.
• Cakir B, Kirbaş I, Cevik B, Ulu EM, Bayrak A, Coşkun M. Complications of continuous ambulatory peritoneal dialysis: evaluation with CT. Diagn Interv Radiol 2008; 14: 212-20.
• Yamada K, Fujimoto S, Nishiura R, Komatsu H, Tatsumoto M, Sato Y, et al. Risk factors of the progression of abdominal aortic calcification in patients on chronic haemodialysis. Nephrol Dial Transplant 2007; 22: 2032-7. [CrossRef]
• Honkanen E, Kauppila L, Wikström B, Rensma PL, Krzesinski JM, Aasarod K, et al. Abdominal aortic calcification in dialysis patients: Results of the CORD study. Nephrol Dial Transplant 2008; 23: 4009-15. [CrossRef]
• Shoji T, Emoto M, Shinohara K, Kakiya R, Tsujimoto Y, Kishimoto H, et al. Diabetes mellitus, aortic stiffness, and cardiovascular mortality in end- stage renal disease. J Am Soc Nephrol 2001; 12: 2117-24.