キックスケートで転倒し病院前心肺停止に至った小児肝破裂の１例 A Pediatric Case of Cardiopulmonary Arrest due to Hepatic Rupture Caused by the Fall during Play with Kicking Skate.
キックスケート(車輪付きデッキ,シャフト,ハンドルバーから構成される遊戯具)による肝損傷で病院前心肺停止状態(CPA-OA)となり救命しえなかった症例を経験した.症例は, 9歳,男児,同遊戯具で走行中転倒しハンドルバーで右側胸部を強打.救急隊現場到着時,不穏状態で呼名に反応せず,血圧測定不能,搬送途中呼吸状態,意識レベル悪化,受傷後約30分で当センター到着, CPA-OAであった.腹部は軽度膨隆,右肋弓に6mmの圧挫痕を認めた.急速輸液,開胸心臓マッサージにより蘇生に成功した.肝破裂と腹腔内出血の増加,血液凝固異常,著しいアシドーシスを認めた.胸部下行大動脈遮断し,救急通報後78分,搬送後46分で緊急手術を施行した.肝右葉の深在性の複雑な破裂損傷に対しperihepatic packing,右肝動脈,門脈右枝結紮術を施行,集中治療室へ入室したが受傷後約15時間で死亡した.
We experienced a pediatric case of cardiopulmonary arrest on arrival (CPA-OA) due to hepatic rupture caused by the fall during play with kicking skate (kickskate), whose life could not be saved despite of intensive treatment. A 9-year-old boy fell down on playing with a kickskate and was struck his right lateral chest by its handlebar. He was confused and restless and didn't respond for voices at the arrival of an ambulance. Emergency paramedics could not measure his blood pressure on the scene. During transportation he lost his consciousness. He was transported to our center 30 minutes after the event in the condition of CPA-OA. His abdomen was distended and a bruise was noticed on his right lateral chest. Resuscitation with rapid infusion and open cardiac massage was successful. Ultrasonography and blood examination showed hepatic rupture, intraperitoneal massive hemorrhage, coagulopathy, and severe acidosis. After clamping descending thoracic aorta, we performed an emergency laparotomy 78 minutes after the emergency call and 46 minutes after admission. We diagnosed his hepatic rupture as complex type of deep injury (IIIb according to the classification proposed by Japanese Association for the Surgery of Trauma), and performed perihepatic packing and ligation of the right hepatic artery and right portal vein. He was transferred to ICU, but died 15 hours after the event.
日本臨床外科学会雑誌 62(7), 1701-1705, 2001