出血シンチグラフィおよび血管造影が有用であった回腸単純性潰瘍の1例  [in Japanese] ILEAL SIMPLE ULCER SUCCESSFULLY DIAGNOSED AND TREATED FOLLOWING ^<99m>Tc-HSA SCINTIGRAPHY AND ANGIOGRAPHY : A CASE REPORT  [in Japanese]

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Abstract

症例は34歳,男性である.過去2回下血にて精査したが,出血源不明であった.今回,腹痛と下血を主訴に当科に入院した.出血シンチグラフィで左下腹部に異常集積がみられ,上腸間膜動脈造影では回腸動脈の末梢枝に血管外漏出像を認めた.マイクロコイルを併用した動脈塞栓術を施したのち,開腹手術を施行した.術中X線透視下にコイルを検索し出血部位を同定,回盲弁から約50cmの部位の回腸を部分切除した.切除標本では露出血管を伴った境界明瞭な潰瘍を認め,病理組織学的には非特異性炎症性潰瘍の像が認められ,回腸単純性潰瘍と診断した.<br>小腸の出血性病変に対しては,通常の消化管造影や内視鏡検査では出血部位の同定に難渋することが多い.出血シンチグラフィや血管造影は,出血源不明の消化管出血に対し,診断のみならず治療にも有用なstrategyになりうると考えられた.

A 34-year-old man was admitted to the hospital because of melena and abdominal pain. He had developed melena twice before admission, but any cause for the hemorrhage had not been identified. <sup>99m</sup>Tc-HSA scintigraphy showed an abnormal accumulation in the left lower abdominal region. Angiography of the superior mesenteric artery demonstrated an extravasation of contrast medium from the peripheral branch of ileal artery. After embolizing the arterial branch superselectively using a microcoil, an emergency lapalotomy was performed. At surgery, the bleeding site was identified at 50cm proximal to the ileocecal valve by using a radiographic device. Partial resection of the ileum was performed and the resected specimen revealed a clearly demarcated ulcer in which an exposed vessel was included. Histological examination confirmed that the lesion was non-specific ulcer, suggestive of simple ulcer of the ileum.<br>Small intestinal hemorrhage is difficult to be diagnosed by routine radiographic or endoscopic examination. The present case suggests that scintigraphy and angiography may be useful strategies not only for diagnosis but also for treatment of intestinal hemorrhage from unknown origin.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 62(1), 158-162, 2001-01-25

    Japan Surgical Association

References:  12

Cited by:  2

Codes

  • NII Article ID (NAID)
    10008387599
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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