血液凝固第VIII因子インヒビター出現が原因となった術後巨大後腹膜血腫の1例  [in Japanese] POSTOPERATIVE GIANT RETROPERITONEAL HEMATOMA DUE TO THE APPEARANCE OFCOAGULATION FACTOR VIII INHIBITOR : A CASE REPORT  [in Japanese]

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Abstract

第VIII因子インヒビター出現による巨大後腹膜血腫の1例を経験した.症例は69歳男性で吐血にて入院,胃噴門部早期癌の診断で手術を施行.術後,吻合部潰瘍からの出血あり再手術施行.再手術後に再び吐血したが保存的治療にて軽快した.しかし2ヵ月後に突然後腹膜に巨大血腫を形成しショック状態となった.凝固検査ではAPTTだけが延長しており,検索にて第VIII因子インヒピター出現による出血傾向と判明.原因は不明であったが,プレドニゾロン投与開始後しばらくしてAPTTは正常に戻った.インヒビターについての免疫学的解析ではIgGタイプの自己抗体であり, IgGサブクラスはIgG<sub>1</sub>,およびIgG<sub>4</sub>であった.第VIII因子インヒビター出現による出血傾向は本症例のように重篤な出血症状を呈することが多く,出血死する頻度も高いため,本疾患に対する認識と迅速な対応が必要である.

A case of giant retroperitoneal hematoma due to the appearance of coagulation factor VIII inhibitor is reported.<br> A 69-year-old man was admitted to the hospital because of hematemesis, and was operated on with a diagnosis of early cancer of the cardiac part of the stomach. After the operation, hemorrhage from ulcer at the anastomosed site occurred which demanded reoperation. Thereafter the patient had hematemesis again but was conservatively managed. Two months later, however, a giant hematoma was abruptly formed at the retroperitoneum and shock occurred. On a coagulation test, a prolongation in APTT alone was noted. Exploration revealed that it was bleeding tendency due to the appearance of the factor VIII inhibitor. The cause was obscure, but the APTT level was normalized for a time after starting the prednisolone regimen. An immunological analysis of the inhibitor demonstrated that it was IgG type autoantibody and IgG1 and IgG4 as IgG subclass.<br> Bleeding tendency due to the appearance of coagulation factor VIII inhibitor often causes severe hemorrhagic symptoms like in this case, with a high mortality rate due to hemorrhage. So the recognition and rapid treatment of the disease are of importance.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 61(2), 495-499, 2000-02-25

    Japan Surgical Association

References:  18

Cited by:  2

Codes

  • NII Article ID (NAID)
    10008502164
  • 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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