鋭的肝外傷後の動門脈シャントを伴う仮性左肝動脈瘤の1例 A Case of a Pseudoaneurysm of the Left Hepatic Artery with an Arterio-Portal Shunt After a Penetrating Hepatic Injury

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著者

    • 梅邑 晃 Umemura Akira
    • 岩手医科大学医学部救急医学講座 Department of Critical Care Medicine, Iwate Medical University School of Medicine
    • 吉川 智宏 Kikkawa Tomohiro
    • 岩手医科大学医学部救急医学講座 Department of Critical Care Medicine, Iwate Medical University School of Medicine
    • 西成 悠 Nishinari Yu
    • 岩手医科大学医学部救急医学講座 Department of Critical Care Medicine, Iwate Medical University School of Medicine
    • 秋冨 慎司 Akitomi Shinji
    • 岩手医科大学医学部救急医学講座 Department of Critical Care Medicine, Iwate Medical University School of Medicine
    • 小鹿 雅博 Kojika Masahiro
    • 岩手医科大学医学部救急医学講座 Department of Critical Care Medicine, Iwate Medical University School of Medicine
    • 井上 義博 Inoue Yoshihiro
    • 岩手医科大学医学部救急医学講座 Department of Critical Care Medicine, Iwate Medical University School of Medicine
    • 遠藤 重厚 Endo Shigeatsu
    • 岩手医科大学医学部救急医学講座 Department of Critical Care Medicine, Iwate Medical University School of Medicine

抄録

症例は53歳,女性。自宅で家族と口論となり発作的に自分の腹部を出刃包丁で刺したため救急車で当院へ搬送された。来院時上腹部に深い刺創があり,腹部CT検査で肝S4にIIIa型損傷を認めた。初期輸液療法に反応したため保存的加療目的に入院となった。受傷2日目に施行した腹部CT検査で左肝動脈の仮性動脈瘤形成と動脈瘤を介した門脈本幹とのarterio-portal(A-P)シャントを認めたため,transcatheter arterial embolization(TAE)を施行した。TAE後,A-Pシャントは消失し,以降順調に経過したため神経精神科へ転科となった。肝外傷後の肝動脈瘤は通常仮性動脈瘤であり,肝損傷後の約1%にみられる合併症である。遅発性肝破裂や胆道出血の原因となるため生命予後を左右する合併症であるが,動脈瘤形成までは受傷後数週間を要するとされる。本症例は,受傷後早期にA-Pシャントを伴う仮性肝動脈瘤を形成した非常にまれな症例であり,TAEにより治療しえたので報告する。

A 53-year-old woman was transported to our clinic by ambulance after suddenly having stabbed herself in the abdomen with a kitchen knife after quarreling with family members at home. The patient had a deep stab wound in her upper abdomen upon arrival, and a grade IIIa hepatic injury (S4) was observed on abdominal CT imaging. The patient was hospitalized for conservative therapy since she responded to initial fluid therapy. Transcatheter arterial embolization (TEA) was performed following the formation of a left hepatic artery pseudoaneurysm, and an arterio-portal (A-P) shunt with the portal vein main trunk via the aneurysm were observed on abdominal CT on day 2. Following TEA, since the A-P shunt was no longer observed and the patient progressed favorably, she was transferred to the department of neuropsychiatry. Hepatic artery aneurysms following hepatic injury are normally pseudoaneurysms that occur as complications in roughly 1% of hepatic injury cases. Although this complication influences the prognosis since it can cause delayed hepatic rupture and biliary tract hemorrhage, several weeks following injury are required until pseudoaneurysm formation. This case was an extremely rare case in which the hepatic pseudoaneurysm formed accompanying A-P shunt soon after that was subsequently treated by TAE, a description of which is reported herein.

収録刊行物

  • 日本腹部救急医学会雑誌

    日本腹部救急医学会雑誌 31(7), 1063-1066, 2011

    日本腹部救急医学会

キーワード

各種コード

  • NII論文ID(NAID)
    130004508961
  • 本文言語コード
    JPN
  • ISSN
    1340-2242
  • データ提供元
    J-STAGE 
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