上腸間膜動脈塞栓症に対する大量腸管切除後に多発動脈塞栓症を合併した1例 [in Japanese] A CASE OF SUPERIOR MESENTERIC ARTERY EMBOLISM WITH MULTIPLE ARTERIAL OCCLUSION INVOLVING THE LEFT LOWER EXTREMITY, LIVER, SPLEEN, AND BILATERAL KIDNEY [in Japanese]
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症例は72歳の女性.以前より発作性心房細動にて治療中であった.平成16年3月11日,著明な腹部膨満と全身状態悪化で救急搬送となった.血圧80mmHgとショック状態で,腎機能も低下,単純CTで拡張した小腸と腹水を認めた.来院後4時間で緊急手術を施行した.空腸起始部50cmから横行結腸右側までが連続性に壊死していたため,上腸間膜動脈閉塞症と診断し小腸亜全摘,結腸右半切除術を施行した. 3PODに左下肢急性動脈閉塞を発症,血栓除去術を行い救肢した.この時点からheparin投与も開始した. 2週間後の腹部造影CT検査ではさらに肝,脾,両側腎の多発梗塞像を認め多発動脈塞栓症と診断した. 47PODに在宅IVH療法目的に軽快転院となった.心疾患を有する動脈塞栓症は多発する可能性を常に念頭に置き,早い時期からheparinを用いた積極的な抗凝固療法が必要と考えられた.
A 72-year-old woman who had been treated for paroxysmal atrial fibrillation was brought into the hospital by ambulance because of abdominal pain and distension. When she arrived at the hospital, she was in a shock state with blood pressure of 80mmHg and impaired renal function. Plain CT scan showed ascites and dilatation of the small intestine. Emergency laparotomy was performed 4 hours after her arrival. A diagnosis of superior mesenteric artery embolism was made, and almost the entire small intestines and right colon which were necrotic were resected. Three days after the operation, she complained of severe pain of her left lower extremity. A diagnosis of acute arterial occulusion was made, and thromboembolectomy for the left lower extremity was performed. After the second operation, anticoagulation therapy with heparin was started. Two weeks later, abdominal CT scan revealed multiple infarction of the liver, spleen and bilateral kidney, indicating so-called shower embolism. She was discharged from the hospital on 47th postoperative day. In the treatment of the ischemic intestine with atrial fibrillation, early start of anticoagulation therapy with heparin is essential for prevention of recurrence or multiple occurrence of arterial thrombosis after the operation.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 67(11), 2742-2746, 2006-11-25
Japan Surgical Association