Cefoperazone/Sulbactam-Induced Abdominal Wall Hematoma and U
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Case Report
The patient (female, 87 years old) was hospitalized on June 16, 2014, because of yellow purulent sputum and cough with dyspnea lasting 5 days. The chest film suggested right lower lung infection and a small amount of pleural effusion on the right side. She had a history of chronic renal insufficiency, blood urea nitrogen was 16.1 mmol/L, and creatinine was 334 µmol/L at the time of admission. There was no bleeding history. The pneumonia was successively treated with mezlocillin and piperacillin/tazobactam, but symptoms did not improve. The antibiotic was upgraded to cefoperazone/sulbactam 4.5 g twice daily intravenous infusion from June 23. The symptoms improved daily. At 4:00, June 30, the patient felt a sudden onset of left lower abdominal pain, associated with subcutaneous mass. This mass was round, 6 × 6 cm in size, and hard to touch. The patient experienced tenderness with no obvious wave motion. Abdominal computed tomography (CT) showed possible hematoma at the lower left abdominal wall (Fig. 1a). Abdominal B ultrasound revealed mixed masses (100 × 36 mm, smooth border, unhomogenous echo) at the left lower abdominal wall (Fig. 1b). The patient had not defecated in the past 48 h, and incarceration of a ventral hernia was considered. Fasting, rehydration, spasmolysis, and acesodyne were implemented, but these measures did not ease the symptoms. At 17:00, June 30, the patient vomited a coffee-colored liquid, about 200 mL. Occult bloods test of vomit were positive....

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