J Korean Soc Traumatol.  2013 Sep;26(3):233-237.

Delayed Traumatic Intracerebral Hemorrhage in Patient with Hemoperitoneum Operation

• Kim S
• Bae K
• Pyen J
• Kim J
• Cho S
• Noh H
• Whang K
• Oh J

Abstract

Delayed traumatic intracerebral hemorrhage (DT-ICH) is a rare event in head trauma patients. However, it develops unexpectedly and results in very severe brain damage. Thus, close monitoring of the neurologic status is needed for every trauma patient. Sometimes, however, neurologic monitoring cannot be done because of sedation, especially in cases of abdominal surgery. In this case report, we describe the case of a 37-yr-old, male patients who had hemoperitoneum because of spleen and renal injury. At the initial operation, massive bleeding was found, so gauze-packing surgery was done first. After the first operation, we sedated the patient for about two days, after which the packed gauze was removed, and the abdominal wound was closed. Immediately after the second operation, we found pupil dilation. Emergent CT was performed. The CT revealed DT-ICH with severe brain edema and midline shifting. However, the patient condition deteriorated progressively despite emergency operation, he expired 2 days after hematoma evacuation.

Keyword

Delayed traumatic intracerebral hemorrhage; Hemoperitoneum; Sedation

MeSH Terms

Brain
Brain Edema
Cerebral Hemorrhage, Traumatic*
Craniocerebral Trauma
Emergencies
Hematoma
Hemoperitoneum*
Hemorrhage
Humans
Male
Pupil
Spleen