大腸の内視鏡的粘膜切除で噴出性出血を来した輸血拒否患者の経験

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  • A SPURTING BLEEDING ON EMR FOR COLONIC ADENOMA OF 40 MM IN A PATIENT WHO REFUSES BLOOD TRANSFUSION, A CASE REPORT

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A 53-year-old woman who refuses blood transfusion based upon her religious belief was referred to our institution. She had 40 mm of a laterally spreading tumor in the transverse colon. Under no sedation, colonoscopy was performed in the Endoscopy Unit . On both plain and magnification chromocolonoscopy, there were no findings suggesting a substantial invasion into the submucosal layer. Endoscopic mucosal resection was selected as an initial treatment . At the first cutting with snaring, spurting bleeding from the thin vessel occurred and then was successfully stopped by endoscopic clipping . Endoscopic resection was continued for the remaining lesion and finally the whole lesion was resected at piecemeal fashion . Absence of recurrent lesion was confirmed by repeat colonoscopies . This paper discussed therapeutic procedure and the management of a large colorectal tumor developing in the patients who refuses blood transfusion based upon their religious belief.

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