冠動脈バイパス術後に虚血性腸疾患を合併した慢性透析の３症例

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  • Intestinal Ischemia after Coronary Artery Bypass Grafting in Three Patients with Hemodialysis.

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We report three cases of hemodialysis (HD) patients who underwent coronary artery bypass grafting. These patients suffered from diseases like severe diabetes and malignant hypertension which are frequently associated with impaired peripheral circulation. The early postoperative course of each patient was uneventful, and all patients were discharged from the ICU within a few days. Then, they developed intestinal ischemia, and required surgical treatment. Two of them received extensive resection of the necrotized intestine, but they died of multiple organ failure. Another patient showed mucosal ischemia, and survived due to an ileostomy. Mesenteric vasoconstriction due to low cardiacoutput, intestinal hypoxia induced by hypotension during HD, mechanical compression of the intestineduring peritoneal dialysis, and bowel distension due to reduced intestinal motility are thought to be responsible for induction and exacerbation of impaired intestinal circulation, resulting in the severe intestinal ischemia.

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