Vasoactive intestinal polypeptide 産生膵腫瘍による大量下痢からの循環・腎機能不全に対し持続的血液濾過透析など生命補助下に腫瘍切除しえた1例  [in Japanese] A Case of Vasoactive Intestinal Polypeptide Secreting Pancreatic Tumor Recovered from Severe Circulation and Renal Disorders by Use of Artificial Support Including Continuous Hemodialysis and Filtration Followed by Distal Pancreatectomy  [in Japanese]

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Abstract

症例は60歳の女性で,1年前より腸炎症状にて輸液治療をされており,低カリウム,脚力低下にても入院歴あり.本年になり糖尿病指摘.交通事故を契機の精査で膵臓に10cm大の腫瘍を指摘された.治療目的で近隣病院に入院中1日あたり5〜8回におよぶ下痢による腎不全となり当院へ転送,循環不全,高度アシドーシス,低カリウムに対し輸液管理,塩酸ロペラミド・酢酸オクトレオチド投与,透析・持続的血液濾過透析で生命維持を図りつつ,臨床症状よりvasoactive intestinal polypeptide産生腫瘍による下痢を疑い,その血清中の高値確認後速やかに膵体尾部切除術を施行した.術後下痢は2日で収束し透析・持続的血液濾過透析より離脱でき救命できた.循環不全,高度アシドーシスで周術期に透析・持続的血液濾過透析を要する危機的状態でも積極的に切除を行うことこそが救命につながり,不良な術前状態に躊躇することなく手術に持ち込むべきと考えられた.

A 60-year-old woman administered intravenous fluid and electrolyte replacement one year for refractory diarrhea, was hospitalized several times for hypokalemia and general muscle weakness. Computed tomography showed a 10cm pancreatic body tumor. She was referred for hemodialysis after her diarrhea caused renal failure. Suspecting vasoactive intestinal polypeptide-secreting tumor, we attempted unsuccessfully to ease the diarrhea with loperamide hydrochloride and octreotide acetate. Hemodialysis, then continuous hemodialysis with filtration, was introduced against circulatory failure, severe acidosis, and renal failure. Distal pancreatectomy was done as soon as high serum vasoactive intestinal polypeptide was identified. Diarrhea subsided within 2 days of surgery, and she was removed from life-support equipment. Even under life-threatening conditions requiring artificial organ support, including continuous hemodialysis and filtration, tumor resection is the only way to enable patients to resume regular lives.

Journal

  • The Japanese journal of gastroenterological surgery

    The Japanese journal of gastroenterological surgery 43(6), 640-646, 2010-06-01

    The Japanese Society of Gastroenterological Surgery

References:  18

Codes

  • NII Article ID (NAID)
    110007656696
  • NII NACSIS-CAT ID (NCID)
    AN00192066
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    03869768
  • Data Source
    CJP  NII-ELS 
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