腎梗塞を合併した外傷性脾破裂の1例 A CASE OF TRAUMATIC RUPTURE OF THE SPLEEN ACCOMPANIED WITH RENAL INFARCTION

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外傷性脾破裂は日常診療上比較的頻繁に遭遇するが腎梗塞を合併することは極めて稀と考えられる.今回われわれは交通事故により脾破裂を生じ緊急手術を施行し,術後経過中に腎梗塞と診断した症例を経験したので報告する.症例は17歳男性.交通事故で腹部を強打し来院した.来院時より血圧低下を示し腹部は膨隆し,著明な圧痛と腹膜刺激症状を認めた.腹部CTでは液体貯溜を認め腹腔内出血が疑われたため緊急手術を施行した.脾には実質まで及ぶ深い裂傷を認め脾摘出術を施行したが,左腎は触診上異常を認めず,後腹膜腔にも出血がみられなかったため腎に対する操作を加えずに手術を終了した.術後経過は良好であったが,術後の腹部CT検査にて左腎の萎縮傾向を認めたため血管造影を施行したところ,左腎動脈の閉塞が確認された.しかし腎血管性高血圧を認めなかったため腎摘出術は施行せず,現在外来にて経過観察中である.

While we sometimes encounter traumatic rupture of the spleen, renal infarction is very rarely accompanied in these cases. This time we experienced a patient emergently operated on for traumatic rupture of the spleen due to a traffic accident who was found to be associated with renal infarction in postoperative course. 17-year-old man was admitted to the hospital because of abdominal blunt injury by the traffic accident. On admission his blood pressure was low and there were distention, severe tenderness and signs of peritoneal irritation in the entire abdomen. Intraperitoneal bleeding was suspected by abdominal CT scanning that revealed fluid retention. Emergency operation was carried out. Because intraoperative findings revealed deep laceration into the parenchyma of the spleen, splenectomy was performed. No injury of the left kidney and no retroperitoneal bleeding were seen, and we finished this operation. Postoperative course was uneventful, but the left kidney tended to be atrophic by postoperative abdominal CT scanning. Angiography revealed occlusion of the left renal artery. But we did not performe total nephrectomy of the left kidney, because renal hypertension in this case was not manifested. The patient is strictly followed up on an ambulant basis.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 58(6), 1363-1367, 1997-06-25

    Japan Surgical Association

参考文献:  11件中 1-11件 を表示

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各種コード

  • NII論文ID(NAID)
    10008528236
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869776
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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