大量下血をきたした,回腸Dieulafoy様潰瘍の1例 : 特に小腸粘膜下動脈瘤(cirsoid aneurysm)破裂との関連と術中色素注入法について A CASE OF DIEULAFOY'S ULCER OF THE ILEUM PRESENTED WITH MASSIVE HEMORRHAGE : IN RELATION TO RUPTURE OF A CIRSOID ANEURYSM OF THE SMALL BOWEL AND INTRAOPERATIVE DYE INJECTION

この論文にアクセスする

この論文をさがす

著者

抄録

症例は56歳男性.急性リンパ性白血病のため化学療法を受けていたが,突然大量の下血を呈しショック状態となった.緊急選択的血管造影で上行結腸出血と判断,開腹するも出血点を見いだせず,人工肛門を造設した. 4日後,人工肛門口側より大量出血があり,再度血管造影を施行し上腸間膜動脈領域の回腸に造影剤の血管外漏出像を認めた.病変部位同定と切除範囲を確実にするため血管造影カテーテルを留置し,術中色素注入により出血病変を含む回腸部分切除術を施行した.回腸の粘膜が一部欠損し,粘膜下層からの太い動脈壁の破綻による大量出血で, Dieulafoy様潰瘍と診断した.同様な所見を呈する疾患に小腸の粘膜下動脈瘤 (cirsoid aneurysm) 破裂があるが,これらはほぼ同じ病態と考えられた.

We report a case of "Dieulafoy's ulcer" in the ileum presented with massive hemorrhage. A 56-year-old man who had been treated for acute lymphocytic lymphoma suddenly had massive anal bleeding and was admitted to the hospital.<br> The site of bleeding was determined mid-ascending colon by an emergency selective superior angiography at first time, but obvious bleeding point was not identified. So an ascending colostomy was undertaken. Four days later, massive bleeding occurred from the oral side of the colostomy of the ascending colon. Emergency selective angiography showed extravasation of contrast medium in the ileum. A catheter was induced into the mesenteric artery supplying the lesion, and the patient was transferred to the operating room immediately. Dye solution was injected intraoperatively, and a blue-stained segment of the ileum was resected.<br> Histologic examination showed an ileal mucosal ulcer with ruptured arteries in the submucosal layer, compatible with Dieulafoy's ulcer. Such lesion has been called by many terms, including "cirsoid aneurysm", and these terms are meant the same disease.

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 60(11), 2945-2949, 1999-11-25

    Japan Surgical Association

参考文献:  12件中 1-12件 を表示

被引用文献:  6件中 1-6件 を表示

各種コード

  • NII論文ID(NAID)
    10008498403
  • 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  CJP引用  J-STAGE 
ページトップへ