脾囊胞自然破裂に対する脾摘後に形成された脾動静脈瘻の1例 A Rare Case of Arteriovenous Fistula of Splenic Vessels After Splenectomy Necessitated by Spontaneous Rupture of a Splenic Cyst

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著者

    • 黒崎 功 Kurosaki Isao
    • 新潟大学大学院医歯学総合研究科消化器・一般外科分野 Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Science
    • 滝沢 一泰 Takizawa Kazuyasu
    • 新潟大学大学院医歯学総合研究科消化器・一般外科分野 Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Science
    • 西倉 健 Nishikura Ken
    • 新潟大学大学院医歯学総合研究科分子・病態病理学分野 Division of Molecular and Functional Pathology, Niigata University, Graduate School of Medical and Dental Science
    • 畠山 勝義 Hatakeyama Katsuyoshi
    • 新潟大学大学院医歯学総合研究科消化器・一般外科分野 Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Science

抄録

症例は78歳の女性で,2002年9月脾囊胞自然破裂による腹腔内出血のため当院にて緊急脾臓摘出術を施行した.その際脾動静脈は数回に分けて一括結紮処理された.その後2006年6月他院での腹部USにて脾静脈拡張を指摘され当科紹介となった.腹部CTにて膵尾部外側に長経約7 cmの,脾静脈と同等に強く造影される腫瘤を指摘された.腹部MRIでは造影早期相にて強い造影効果を呈し,さらに,拡張した門脈にも造影効果を認めたことから脾動静脈瘻と診断し手術適応と考え,前回手術から3年11か月後に手術を施行した.開腹所見では膵尾部外側の,脾動静脈の断端に約7 cm径のスリルを伴う血流豊富な腫瘤を認め脾動静脈瘻と診断した.手術は脾動静脈をそれぞれ結紮切離し腫瘤切除を行った.術後経過は良好であった.脾摘の際に脾動静脈を一括結紮切離したことが原因になり脾動静脈瘻が形成されたと考えられる,まれな1例を経験したので報告する.

A 78-year-old woman underwent splenectomy under a diagnosis of intraabdominal bleeding caused by spontaneous rupture of a splenic cyst in September 2002. During the operation, splenic vessels were dissected by mass ligation of the artery and vein. About 4 years after the operation, the then asymptomatic patient was found to have dilatation of the splenic vein by abdominal US and was referred to our hospital in June 2006. Abdominal CT films showed a well-enhanced tumor, 7-cm with the same density as the splenic vein, located in the neighborhood of the pancreatic tail. Abdominal MRI films demonstrated that the tumor was markedly enhanced in the early phase and at the same time the slightly dilated portal vein was well-enhanced. Thus the tumor was diagnosed as arteriovenous fistula of the splenic vessels, and the operation was performed 3 years and 11 months after the previous splenectomy. Laparotomy showed the tumor had abundant pulsatile arterial blood flow, necessitating fistulectomy with ligation and resection of each splenic artery and vein. The Operative diagnosis was also splenic arteriovenous fistula, which was considered to have been derived from mass ligation of the splenic artery and vein. Cases of postsplenectomy arteriovenous fistula of the splenic vessels are very rare in Japan.

収録刊行物

  • 日本消化器外科学会雑誌

    日本消化器外科学会雑誌 45(8), 850-856, 2012

    The Japanese Society of Gastroenterological Surgery

各種コード

  • NII論文ID(NAID)
    130004560864
  • 本文言語コード
    JPN
  • ISSN
    0386-9768
  • データ提供元
    J-STAGE 
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