小腸の器械吻合部の遅発性出血によりショックとなった1例 DELAYED BLEEDING FROM ANASTOMOTIC SITE AFTER THE STAPLED FUNCTIONAL END-TO-END ANASTOMOSIS FOR SMALL INTESTINAL RECONSTRUCTION : A CASE REPORT

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症例は64歳男性.貧血の精査中, CTにて腹腔内腫瘍を指摘され開腹術にて小腸gastrointestinal stromal tumor (GIST)と診断された.空腸部分切除を行い,再建に器械吻合によるfunctional end to end anastomosis (以下FEEA)を施行した.術後第9日目より多量の下血がみられ翌日にはショック状態となった.緊急腹部血管撮影を施行し静脈相で空腸吻合部にpooling signとextravasationを認めたため吻合部出血と診断し,吻合部を含めた小腸部分切除を施行した.この後出血は完全にコントロールされ術後1年の現在再出血をみていない.病理学的にstaple lineに沿った吻合部粘膜に多量の赤血球を伴う鬱血を認め, FEEAによる遅発性小腸出血と診断した.

A 64-year-old man being monitored for anemia was found on computed tomography to have a tumor in the abdominal cavity. This tumor was diagnosed as a gastrointestinal stromal tumor at laparotomy. Partial jejunal resection was conducted and intestinal reconstruction made by functional end-to-end anastomosis (FEEA) with a linear cutter device. Massive delayed intestinal bleeding occurred on postoperative day (POD) 9, and the patient went into shock on POD 10. Emergent abdominal angiography showed pooling and extravasation near the FEEA site. Emergency laparotomy was done and the jejunum including the FEEA site was partially resected. Bleeding was controlled and no rebleeding occurred in the 1 year since surgery. FEEA site bleeding was diagnosed in postoperative pathological findings.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 63(2), 392-394, 2002-02-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10008393556
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  J-STAGE 
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