87歳肝血管腫自然破裂の1例  [in Japanese] A Case of Sponaneous Rupture of Liver Hemangioma in a Very Elderly  [in Japanese]

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Author(s)

    • 片寄 友 KATAYOSE Yu
    • 東北大学大学院消化器外科学|東北大学大学院統合がん治療外科学 Department of Surgery, Tohoku University Graduate School of Medicine|Department of Integrated Surgery and Oncology, Tohoku University Graduate School of Medicine
    • 高瀬 圭 TAKASE Kei
    • 東北大学放射線診断科 Department of Diagnostic Radiology, Tohoku University Hospital
    • 海野 倫明 UNNO Michiaki
    • 東北大学大学院消化器外科学|東北大学大学院統合がん治療外科学 Department of Surgery, Tohoku University Graduate School of Medicine|Department of Integrated Surgery and Oncology, Tohoku University Graduate School of Medicine

Abstract

症例は87歳,女性.30年前に肝血管腫に対し肝外側区域切除術の既往がある.7年前より肝尾状葉に5cm大の血管腫が指摘されていたが,増大傾向は認めなかった.2014年2月に外傷の既往なく突然の胸痛を自覚し,前医を受診,造影CT検査で肝尾状葉の血管腫から腹腔内へ造影剤の漏出を認め,肝血管腫の自然破裂と診断され,加療目的に当院に緊急搬送された.経カテーテル的動脈塞栓術を施行し止血した.術後合併症なく経過,再出血のリスクも考えられたが,超高齢であることを考慮し十分にインフォームドコンセントの上,肝切除は行わない方針とし,第15病日に退院となった.現在,術後12カ月経過したが,再破裂なく経過している.肝血管腫の自然破裂はまれであり,本症例は本邦報告例では最高齢である.経カテーテル的動脈塞栓術後に肝切除せず経過観察とした報告もなく,治療方針に関して今後の参考になる症例と考えられ,文献的考察を加え報告する.

An 87-year-old woman who underwent lateral segmentectomy of liver for hemangioma 30 years earlier had been diagnose with a hemangioma at the caudate lobe since 7 years earlier. The hemangioma did not show any increasing tendency. In February 2014, she had the sudden onset of chest pain without history of trauma and visited a previous hospital. A contrast-enhanced CT scan revealed leakage of contrast material from the hemangioma in the caudate lobe to the abdominal cavity. The patient was diagnosed with spontaneous rupture of the hepatic hemangioma and was transferred to our hospital. Hemostasis was achieved by transcatheter arterial embolization. The course was uneventful without any complications. We considered her to be at high risk of having bleeding again, but after giving informed consent, we determined not to perform hepatectomy due to high risk for operation. She was discharged from our hospital on the 15<SUP>th</SUP> postoperative day, and there were no further episodes of rupture at 12 months after the transcatheter arterial embolization.<BR>Spontaneous rupture of hepatic hemangioma is rare. There have been no reports of only transcatheter arterial embolization without hepatectomy for ruptured hepatic hemangioma. We present a case and a review of the literature.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 76(6), 1469-1473, 2015

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130005116754
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • Data Source
    J-STAGE 
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