墜落外傷による左心房破裂の１救命例
40歳代女性が建物３階から墜落して受傷し，ショック状態で当救命救急センターに搬送された．前胸部中央に打撲痕があり，FAST（focused assessment with sonography for trauma）は左胸腔内のみ陽性で，造影CT検査にて多発顔面骨骨折，縦隔気腫，左血気胸・肺挫傷，肝損傷，左恥坐骨骨折が認められた．左右の肝動脈と両側外頸動脈からの血管外漏出に対し経カテーテル動脈塞栓術（transcatheter arterial embolization：TAE）を施行後，留置した左側胸腔ドレーンからの出血が増大したため，緊急左側方開胸術を行った．肺挫傷に対し肺部分切除術を施行...
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| Published in | Journal of the Japanese Association for the Surgery of Trauma Vol. 31; no. 1; pp. 36 - 40 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本外傷学会
2017
The Japanese Association for the Surgery of Trauma |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-6264 2188-0190 |
| DOI | 10.11382/jjast.31.36 |
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| Abstract | 40歳代女性が建物３階から墜落して受傷し，ショック状態で当救命救急センターに搬送された．前胸部中央に打撲痕があり，FAST（focused assessment with sonography for trauma）は左胸腔内のみ陽性で，造影CT検査にて多発顔面骨骨折，縦隔気腫，左血気胸・肺挫傷，肝損傷，左恥坐骨骨折が認められた．左右の肝動脈と両側外頸動脈からの血管外漏出に対し経カテーテル動脈塞栓術（transcatheter arterial embolization：TAE）を施行後，留置した左側胸腔ドレーンからの出血が増大したため，緊急左側方開胸術を行った．肺挫傷に対し肺部分切除術を施行後，心膜損傷を伴う稀な左心房天井部破裂を確認した．自己心膜パッチを用いて心膜横洞を閉鎖空間にし，外科用接着剤を充填することで損傷部を被覆し止血を得て救命に至った．経過は良好で，術後61日目に転院した．本例に用いた方法は，人工心肺使用困難例における治療の選択肢として有用と考えられた． |
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| AbstractList | A woman in her forties was brought to our critical care center in shock after a 3-story fall. Blunt force trauma was observed on the anterior aspect of the thorax and a FAST exam revealed fluid collection only in the left thoracic cavity. Contrast-enhanced computed tomography demonstrated multiple facial fractures, a pneumomediastinum, left hemopneumothorax and pulmonary contusion, right hepatic injury and a left ischiopubic fracture. During transarterial embolization for post-traumatic extravasation from the bilateral hepatic and external carotid arteries, continuous evacuation of blood was observed from the left thoracostomy tube, and therefore, an emergency left lateral thoracotomy was performed, whereby an active hemorrhage from the pulmonary contusion was identified and partially resected. Further bleeding from the dorsal aspect of the heart was noted and subsequently diagnosed as a rupture of the left atrial roof complicated by pericardial injury. Hemostasis was achieved using a pericardial patch and surgical sealant to seal off the transverse pericardial sinus, which ultimately saved the patient's life. The post-operative course was uneventful and the patient was stabilized and transferred to another hospital 61 days postoperatively. The method described in this report is an effective treatment option in cases such as this where the use of heart-lung machines is considerably restricted.
40歳代女性が建物３階から墜落して受傷し，ショック状態で当救命救急センターに搬送された．前胸部中央に打撲痕があり，FAST（focused assessment with sonography for trauma）は左胸腔内のみ陽性で，造影CT検査にて多発顔面骨骨折，縦隔気腫，左血気胸・肺挫傷，肝損傷，左恥坐骨骨折が認められた．左右の肝動脈と両側外頸動脈からの血管外漏出に対し経カテーテル動脈塞栓術（transcatheter arterial embolization：TAE）を施行後，留置した左側胸腔ドレーンからの出血が増大したため，緊急左側方開胸術を行った．肺挫傷に対し肺部分切除術を施行後，心膜損傷を伴う稀な左心房天井部破裂を確認した．自己心膜パッチを用いて心膜横洞を閉鎖空間にし，外科用接着剤を充填することで損傷部を被覆し止血を得て救命に至った．経過は良好で，術後61日目に転院した．本例に用いた方法は，人工心肺使用困難例における治療の選択肢として有用と考えられた． 40歳代女性が建物３階から墜落して受傷し，ショック状態で当救命救急センターに搬送された．前胸部中央に打撲痕があり，FAST（focused assessment with sonography for trauma）は左胸腔内のみ陽性で，造影CT検査にて多発顔面骨骨折，縦隔気腫，左血気胸・肺挫傷，肝損傷，左恥坐骨骨折が認められた．左右の肝動脈と両側外頸動脈からの血管外漏出に対し経カテーテル動脈塞栓術（transcatheter arterial embolization：TAE）を施行後，留置した左側胸腔ドレーンからの出血が増大したため，緊急左側方開胸術を行った．肺挫傷に対し肺部分切除術を施行後，心膜損傷を伴う稀な左心房天井部破裂を確認した．自己心膜パッチを用いて心膜横洞を閉鎖空間にし，外科用接着剤を充填することで損傷部を被覆し止血を得て救命に至った．経過は良好で，術後61日目に転院した．本例に用いた方法は，人工心肺使用困難例における治療の選択肢として有用と考えられた． |
| Author | 玉田, 尚 樽井, 武彦 海田, 賢彦 山口, 芳裕 大田原, 正幸 土屋, 博司 稲葉, 雄亮 守永, 広征 庄司, 高裕 窪田, 博 加藤, 聡一郎 宮国, 泰彦 山田, 賢治 宮内, 洋 |
| Author_FL | YAMAGUCHI Yoshihiro SHOJI Takahiro KATO Soichiro TARUI Takehiko KAITA Yasuhiko INABA Yusuke MIYAUCHI Hiroshi OTAWARA Masayuki TAMADA Nao YAMADA Kenji MORINAGA Hiroyuki KUBOTA Hiroshi MIYAKUNI Yasuhiko TSUCHIYA Hiroshi |
| Author_FL_xml | – sequence: 1 fullname: MIYAKUNI Yasuhiko – sequence: 2 fullname: YAMADA Kenji – sequence: 3 fullname: MORINAGA Hiroyuki – sequence: 4 fullname: OTAWARA Masayuki – sequence: 5 fullname: KATO Soichiro – sequence: 6 fullname: SHOJI Takahiro – sequence: 7 fullname: KAITA Yasuhiko – sequence: 8 fullname: TAMADA Nao – sequence: 9 fullname: MIYAUCHI Hiroshi – sequence: 10 fullname: TARUI Takehiko – sequence: 11 fullname: INABA Yusuke – sequence: 12 fullname: TSUCHIYA Hiroshi – sequence: 13 fullname: KUBOTA Hiroshi – sequence: 14 fullname: YAMAGUCHI Yoshihiro |
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| References | 8) Leavitt BJ, Meyer JA, Morton JR, et al : Survival following nonpenetrating traumatic rupture of cardiac chambers. Ann Thorac Surg 1987 ; 44 : 532-535. 11) Alameddine AK, Alimov VK, Alvarez C, et al : Unexpected traumatic rupture of left atrium mimicking aortic rupture. J Emerg Trauma Shock 2014 ; 7 : 310-312. 15) Chen S-W, Huang Y-K, Liao C-H, et al : Right massive haemothorax as the presentation of blunt cardiac rupture : the pitfall of coexisting pericardial laceration. Interact Cardiovasc Thorac Surg 2014 ; 18 : 245-247. 3) Pocar M, Passolunghi D, Bregasi A, et al : TachoSil for postinfarction ventricular free wall rupture. Interact Cardiovasc Thorac Surg 2012 ; 14 : 866-867. 6) EI-Menyar A, AI-Thani H, Zarour A, et al : Understanding traumatic blunt cardiac injury. Ann Card Anaesth 2012 ; 15 : 287-295. 12) Aun F, Marques EF, Stolf NAG, et al : Successful repair of left ventricular rupture due to blunt trauma. A case report. Rev Hosp Clin Fac Med S Paulo 1975 ; 30 : 222-224. 1) Brathwaite CE, Rodriguez A, Turney SZ, et al : Blunt traumatic cardiac rupture. A 5-year experience. Ann Surg 1990 ; 212 : 701-704. 14) Fulda G, Brathwaite CEM, Rodriguez A, et al : Blunt traumatic rupture of the heart and pericardium. A ten-year experience (1979-1989). J Trauma 1991 ; 31 : 167-173. 16) Baker L, Almadani A, Ball CG : False negative pericardial focused assessment with sonography for trauma examination following cardiac rupture from blunt thoracic trauma : a case report. J Med Case Rep 2015 ; 9 : 155-157. 9) Williams JB, Silver DG, Laws HL : Successful management of heart rupture from blunt trauma. J Trauma 1981 ; 21 : 534-537. 10) Ryu DW, Lee SY, Lee MK : Rupture of the left atrial roof due to blunt trauma. Interact Cardiovasc Thorac Surg 2013 ; 17 : 912-913. 7) Martin TD, Flynn TC, Rowlands BJ, et al : Blunt cardiac rupture. J Trauma 1984 ; 24 : 287-290. 13) Akar İ, İnce İ, Asian C, et al : Left atrial rupture due to blunt thoracic trauma. Ulus Travma Acil Cerrahi Derg 2015 ; 303-305. 4) Agrifoglio M, Barili F, Kassem S, et al : Sutureless patch-and-glue technique for the repair of coronary sinus injuries. J Thorac Cardiovasc Surg 2007 ; 134 : 522-523. 5) Parmley LF, Manion WC, Mattingly TW : Nonpenetrating traumatic injury of the heart. Circulation 1958 ; 18 : 371-396. 2) Teixeria PG, Inaba K, Oncel D, et al : Blunt cardiac rupture : a 5-year NTDB analysis. J Trauma 2009 ; 67 : 788-791. |
| References_xml | – reference: 15) Chen S-W, Huang Y-K, Liao C-H, et al : Right massive haemothorax as the presentation of blunt cardiac rupture : the pitfall of coexisting pericardial laceration. Interact Cardiovasc Thorac Surg 2014 ; 18 : 245-247. – reference: 16) Baker L, Almadani A, Ball CG : False negative pericardial focused assessment with sonography for trauma examination following cardiac rupture from blunt thoracic trauma : a case report. J Med Case Rep 2015 ; 9 : 155-157. – reference: 12) Aun F, Marques EF, Stolf NAG, et al : Successful repair of left ventricular rupture due to blunt trauma. A case report. Rev Hosp Clin Fac Med S Paulo 1975 ; 30 : 222-224. – reference: 3) Pocar M, Passolunghi D, Bregasi A, et al : TachoSil for postinfarction ventricular free wall rupture. Interact Cardiovasc Thorac Surg 2012 ; 14 : 866-867. – reference: 6) EI-Menyar A, AI-Thani H, Zarour A, et al : Understanding traumatic blunt cardiac injury. Ann Card Anaesth 2012 ; 15 : 287-295. – reference: 13) Akar İ, İnce İ, Asian C, et al : Left atrial rupture due to blunt thoracic trauma. Ulus Travma Acil Cerrahi Derg 2015 ; 303-305. – reference: 4) Agrifoglio M, Barili F, Kassem S, et al : Sutureless patch-and-glue technique for the repair of coronary sinus injuries. J Thorac Cardiovasc Surg 2007 ; 134 : 522-523. – reference: 5) Parmley LF, Manion WC, Mattingly TW : Nonpenetrating traumatic injury of the heart. Circulation 1958 ; 18 : 371-396. – reference: 9) Williams JB, Silver DG, Laws HL : Successful management of heart rupture from blunt trauma. J Trauma 1981 ; 21 : 534-537. – reference: 1) Brathwaite CE, Rodriguez A, Turney SZ, et al : Blunt traumatic cardiac rupture. A 5-year experience. Ann Surg 1990 ; 212 : 701-704. – reference: 14) Fulda G, Brathwaite CEM, Rodriguez A, et al : Blunt traumatic rupture of the heart and pericardium. A ten-year experience (1979-1989). J Trauma 1991 ; 31 : 167-173. – reference: 7) Martin TD, Flynn TC, Rowlands BJ, et al : Blunt cardiac rupture. J Trauma 1984 ; 24 : 287-290. – reference: 2) Teixeria PG, Inaba K, Oncel D, et al : Blunt cardiac rupture : a 5-year NTDB analysis. J Trauma 2009 ; 67 : 788-791. – reference: 11) Alameddine AK, Alimov VK, Alvarez C, et al : Unexpected traumatic rupture of left atrium mimicking aortic rupture. J Emerg Trauma Shock 2014 ; 7 : 310-312. – reference: 8) Leavitt BJ, Meyer JA, Morton JR, et al : Survival following nonpenetrating traumatic rupture of cardiac chambers. Ann Thorac Surg 1987 ; 44 : 532-535. – reference: 10) Ryu DW, Lee SY, Lee MK : Rupture of the left atrial roof due to blunt trauma. Interact Cardiovasc Thorac Surg 2013 ; 17 : 912-913. |
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| Snippet | 40歳代女性が建物３階から墜落して受傷し，ショック状態で当救命救急センターに搬送された．前胸部中央に打撲痕があり，FAST（focused assessment with sonography for... A woman in her forties was brought to our critical care center in shock after a 3-story fall. Blunt force trauma was observed on the anterior aspect of the... |
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| SubjectTerms | blunt chest trauma cardiac rupture pericardial injury 心破裂 心膜損傷 鈍的胸部外傷 |
| Title | 墜落外傷による左心房破裂の１救命例 |
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