消化管出血に対する非手術的治療　　消化管出血における非手術的治療の限界―なぜ緊急手術の必要性―

DOI 被引用文献3件 参考文献26件

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タイトル別名
  • Limitations of Conservative Hemostatic Therapy-An Investigation of Cases Requiring Emergent Operations for Digestive Organ Bleeding
  • An Investigation of Cases Requiring Emergent Operations for Digestive Organ Bleeding
  • なぜ緊急手術の必要性

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Conservative hemostatic therapy using endoscopy and interventional radiology has recently improved the treatment of digestive organ bleeding. However, arterial bleeding control and orientation remains difficult in some cases. We retrospectively investigated 14 patients who required surgery to correct digestive organ bleeding ; all of the patients had been treated at our hospital between 1999 and 2004. Five of the patients had gastric ulcer bleeding, three had duodenal ulcer bleeding, four had hemorrhaging from colonic diverticula, one had hemorrhaging from a jejunal diverticulum, and one had hemorrhaging from an ileal diverticulum. The gastric ulcers were located in the lesser curve, while the colonic diverticula were located on the right side. Emergent operations were performed because of relapses in two cases, invalid conservative therapies in five cases, the need to prevent intestinal necrosis after transcatheter arterial embolization (TAE) in one case, impossible conservative therapies in five cases, and orientation difficulties in one case. Six gastrectomies, two resections of the small intestine, four colectomies, one pancreatoduodenectomy, and one arterial suturing were performed. Three patients died because their bleeding could not be controlled. Patients with active bleeding from gastric ulcers in the upper lesser curve or duodenal ulcers and patients with relapsed right colonic diverticula bleeding may require immediate surgery. For bleeding in the small intestine, intraoperative endoscopy may be necessary for orientation.

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