RESUMO
We describe here the case of a 62-year-old man with acute abdominal syndrome and severe hemorrhagic shock following successful thrombolysis for acute cardiac infarction. Emergency surgical exploration revealed extensive intraperitoneal and retroperitoneal hemorrhage resulting from the rupture of a large adrenal tumor. The diagnosis of pheochromocytoma was confirmed by histological findings. The patient died a few hours after surgery from multiorgan failure despite resuscitation attempts. This report discusses the diagnosis difficulties, treatment approach, and relevant literature.
Nous rapportons l'observation d'un patient âgé de 62 ans, qui présente un syndrome abdominal douloureux aigu associé à un choc hémorragique sévère au décours d'une thrombolyse pour infarctus du myocarde. L'exploration chirurgicale urgente objective une hémorragie extensive retro- et intra péritonéale secondaire à une rupture d'une masse surrénalienne. Le diagnostic de phéochromocytome a été confirmé par l'examen histologique de la pièce opératoire. L'évolution était rapidement fatale, aboutissant au décès du patient par défaillance multi-viscérale quelques heures en postopératoire. Seront discutés à travers cette observation et une revue de la littérature, les difficultés diagnostiques et de prise en charge de cette redoutable complication.
Assuntos
Síndrome Maligna Neuroléptica/etiologia , Hemorragia Subaracnóidea/etiologia , Vasculite do Sistema Nervoso Central/diagnóstico , Adulto , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Clorpromazina/efeitos adversos , Clorpromazina/uso terapêutico , Feminino , Humanos , Esquizofrenia/tratamento farmacológico , Hemorragia Subaracnóidea/patologiaRESUMO
INTRODUCTION: The self-mutilating patient is an unusual psychiatric presentation in the emergency room. Nonetheless, serious underlying psychiatric pathology and drug abuse are important background risk factors. A careful stepwise approach in the emergency room is essential, although the prognosis, follow-up, and eventual rehabilitation can be problematic.We present a unique and original case of bilateral self-castration caused by cannabis abuse. CASE PRESENTATION: We report a case of a 40-year-old Berber man, who was presented to our emergency room with externalization of both testes using his long fingernails, associated with hemodynamic shock. After stabilization of his state, our patient was admitted to the operating room where hemostasis was achieved. CONCLUSION: The clinical characteristics of self-mutilation are manifold and there is a lack of agreement about its etiology. The complex behavior associated with drug abuse may be one cause of self-mutilation. Dysfunction of the inhibitory brain circuitry caused by substance abuse could explain why this cannabis-addicted patient lost control and self-mutilated. To the best of our knowledge, this is the first case report which presents an association between self-castration and cannabis abuse.
