塞栓除去術およびsecond look procedureにて治療した急性上腸間膜動脈塞栓症の1例  [in Japanese] SECOND LOOK PROCEDURE AFTER EMBOLECTOMY FOR ACUTE MESENTERIC ARTERY EMBOLISM : A CASE REPROT  [in Japanese]

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Abstract

急性上腸間膜動脈塞栓症の治療においては,早期の診断と切除腸管をより少なくする努力が重要である.われわれは急性上腸間膜動脈塞栓症に対して,塞栓除去術を施行し,その約40時間後にsecond look procedureを行い小腸切除を小範囲にとどめ得た症例を経験したので報告する.症例は71歳男性,上腹部痛にて救急搬送された.腹部血管造影検査の結果,上腸間膜動脈本幹に完全閉塞を認め本症と診断した.発症約9時間後に開腹,上部小腸約25cmを除き全小腸が暗赤色に変色し蠕動もなかった.塞栓血栓除去術を行い閉腹した.約40時間後に再開腹を行った.おおむね小腸の色,蠕動とも良好であったが壊死に陥っている部分が散在する約150cmの範囲の小腸切除を行った.患者は発症66日目突然の心停止を生じ死亡した.本症の治療において,血行再建術とsecond look procedureは,腸管の切除範囲をより少なくすることが可能で,生存率, QOLの向上に貢献しうると思われた.

Acute mesenteric artery embolism is a curable disease if the diagnosis and therapy are instituted before irreversible changes have occurred. We experienced a case of acute mesenteric artery embolism which was treated by second look procedure about 40 hours after embolectomy that permitted us to excise the small intestine in a minimal range.<br> A 71-year-old man was admitted to the hospital because of severe abdominal pain. Superior mesenteric artery angiogram demonstrated embolus completely occluding the SMA. Emergency laparotomy was performed. Large segment of the intestine revealed ischemic change. We performed embolectomy of SMA. About 40 hours after embolectomy, second look procedure was performed. Only small segment of the intestine was necrosed. Bowel resection about 150 cm and anstomosis was carried out. The patient died of cardiac arrest on the 66th day after onset of th diseases. Second look procedure after embolectomy appears useful for evaluation of bowel viability.

Journal

  • The journal of the Japanese Practical Surgeon Society

    The journal of the Japanese Practical Surgeon Society 57(3), 615-618, 1996-03-25

    Japan Surgical Association

References:  6

Cited by:  7

Codes

  • NII Article ID (NAID)
    10008519812
  • NII NACSIS-CAT ID (NCID)
    AN00198696
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03869776
  • Data Source
    CJP  CJPref  J-STAGE 
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