혈액투석 중인 다낭신 환자에서 발생한 간낭종 파열 1예

Abstract

Autosomal dominant polycystic kidney disease (ADPKD) is usually accompanied with cystic change of other organs, especially in liver. Although hepatic cysts may be presented with abdominal pain or infected cysts, rupture of hepatic cyst is rarely encountered. A 74-year-old female undergoing maintenance hemodialysis for ADPKD-induced end stage renal disease was admitted because of abdominal pain. She recently received intermittent urokinase instillation into her cuffed internal jugular venous catheter. During the admission, a sudden onset of diffuse abdominal pain occurred after hemodialysis and repeated urokinase instillation. The abdominal CT revealed rupture of hepatic cysts with perihepatic fluid collection. With supportive care and heparin-free hemodialysis, symptoms were improved. The abdominal CT taken after 3 weeks showed no evidence of hepatic cyst rupture. The possibility of hepatic cyst rupture should be considered when abdominal pain occurs in dialysis patients with ADPKD. We need to be very cautious when they are exposed to anticoagulants or thrombolytic agents.