仮性動脈瘤胆道穿破の2症例  [in Japanese] Two cases of hemobilia caused by a rupture of pseudoaneurysm  [in Japanese]

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Abstract

<p>症例1:66歳女性.切除不能膵癌に対し化学療法施行中,下血を来し入院となった.造影CTにて胆道出血が疑われ,S状結腸に逸脱した胆管金属ステントを認めた.ERCPを施行するも,活動性出血は認められず経過観察とした.第8病日に吐血があり再度CTを施行すると,造影剤の胆道流出を伴う膵十二指腸動脈瘤を認め,動脈塞栓術にて止血した.症例2:67歳男性.門脈腫瘍栓を伴う肝癌に対し陽子線治療後,再発なく経過していたが,胆嚢炎を発症し入院となり,同日PTGBDを施行した.翌日,ドレーンより血性胆汁の流出を認め造影CTを施行したところ,右肝動脈瘤破裂と診断された.広範な門脈血栓を合併していたため動脈塞栓術は困難と判断し,冠動脈用ステントグラフトを留置し止血を得た.</p><p>異なる背景,機序により仮性動脈瘤胆道穿破を来した2症例を経験した.肝胆膵疾患治療の進歩と多様化に伴い,胆道出血は注意を要する合併症である.</p>

<p>Case 1: A 66-years-old woman was hospitalized with melena during chemotherapy for pancreatic cancer. Although hemobilia was suspected with CT, it was not confirmed by ERCP. When she vomited blood on the 8th day, CT demonstrated pancreaticoduodenal artery aneurysm accompanied by biliary extravasation, which was considered as the cause of the hemobilia. Successful hemostasis was obtained with transarterial embolization (TAE). Case 2: A 67-years-old man was hospitalized with cholecystitis. He had been curatively treated with proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus. Although PTGBD was performed on the day of hospitalization, the bile turned bloody color the next day. A rupture of right hepatic artery aneurysm was confirmed with CT. Because TAE was difficult for the extensive portal vein thrombus, a coronary stent was placed and hemostasis was obtained.</p><p>Hemobilia is the complication that should be taken into consideration, along with progress and diversification of treatments for hepatobiliary pancreatic diseases.</p>

Journal

  • Tando

    Tando 33(4), 768-776, 2019

    Japan Biliary Association

Codes

  • NII Article ID (NAID)
    130007738944
  • Text Lang
    JPN
  • ISSN
    0914-0077
  • Data Source
    J-STAGE 
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