対照的な手術所見を呈した高度門脈ガス血症の2例  [in Japanese] Two Cases Operated on for Advanced Portal Venous Gas, with Contrasting Operative Courses  [in Japanese]

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Abstract

症例1は84歳の女性で,上腹部痛と嘔気を主訴に救急搬送された。腹部造影CT検査では,高度な門脈ガス血症とイレウス像を認めた。代謝性アシドーシスの進行を認めたため,緊急手術を施行した。回腸から右側結腸まで非連続性の虚血性変化を認め,同部を広範囲切除した。腸間膜動脈の閉塞性所見は認めず,非閉塞性腸間膜虚血症が疑われた。術後,第39病日目に退院となった。症例2は79歳の女性で,上腹部痛と嘔気で近医を受診した。開腹歴があるため術後イレウスが疑われ,当院へ紹介となった。腹部造影CT検査で,高度の門脈ガス血症と小腸の壁内ガス像を認めた。強い腹痛と代謝性アシドーシスのため腸管壊死を疑い,緊急手術を施行した。開腹所見では,術後の癒着を認めたが腸管の虚血性変化は認めず,癒着剥離術を施行し,第28病日目に退院となった。本2例は高度な門脈ガス血症を認め臨床所見が類似していたが,腸管壊死の有無が対照的な症例であったので報告する。

Case 1 was an 84-year-old woman who was admitted to our hospital because of sudden upper abdominal pain and nausea. An abdominal CT scan revealed advanced portal venous gas and ileus. Since the development of pain and metabolic acidosis appeared, we performed an emergency operation. As irregular necrosis from the ileum to the right hemi-colon was observed, we resected the necrotic intestine. There was no occlusion of the mesenteric artery. We diagnosed the patient as having non-occlusive mesenteric ischemia. She was discharged on postoperative day 39. Case 2 is a 79-year-old woman referred to our hospital following the sudden onset of upper abdominal pain and nausea with a diagnosis of post-operative ileus. An abdominal CT scan revealed advanced portal venous gas and pneumatosis intestinalis. As strong abdominal pain and metabolic acidosis were observed at the first hospital visit, we performed an emergency operation under the diagnosis of intestinal necrosis. Intraoperatively, only postoperative adhesion was observed, without any ischemic change in the intestine. An adhesiotomy was performed, and the patient was discharged on postoperative day 28. Interestingly, these two clinical findings appeared quite similar, but had a contrasting operative course.

Journal

  • Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine)

    Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) 31(7), 1083-1086, 2011

    Japanese Society for Abdominal Emergency Medicine

Codes

  • NII Article ID (NAID)
    130004508966
  • Text Lang
    JPN
  • ISSN
    1340-2242
  • Data Source
    J-STAGE 
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