重症急性膵炎に合併した回結腸仮性動脈瘤と感染性walled-off necrosisに対して血管塞栓術と経皮的ドレナージで治癒し得た1例
症例は70歳代，男性。アルコール性重症急性膵炎の診断で他病院に入院した。退院2ヵ月後に再度上腹部痛が出現し，貧血の増悪を認めたため当院に転院となった。腹部造影CT検査所見では，膵頭部に長径7cmのwalled-off necrosis（WON）と回結腸動脈領域に2.5cmの仮性動脈瘤を認め，血管塞栓術を施行した。経過中に右腎臓から腸腰筋にかけて長径13cmのWONの増大を認め，感染の合併を認めた。内視鏡的経消化管的アプローチが困難な部位であり，経皮経肝的ドレナージ術を施行した。ドレナージチューブのサイズアップと2本挿入することで生理食塩水による大量洗浄と還流が可能となり，WONは縮小し，治癒し...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 35; no. 6; pp. 801 - 804 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本腹部救急医学会
2015
Japanese Society for Abdominal Emergency Medicine |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.35.801 |
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| Abstract | 症例は70歳代，男性。アルコール性重症急性膵炎の診断で他病院に入院した。退院2ヵ月後に再度上腹部痛が出現し，貧血の増悪を認めたため当院に転院となった。腹部造影CT検査所見では，膵頭部に長径7cmのwalled-off necrosis（WON）と回結腸動脈領域に2.5cmの仮性動脈瘤を認め，血管塞栓術を施行した。経過中に右腎臓から腸腰筋にかけて長径13cmのWONの増大を認め，感染の合併を認めた。内視鏡的経消化管的アプローチが困難な部位であり，経皮経肝的ドレナージ術を施行した。ドレナージチューブのサイズアップと2本挿入することで生理食塩水による大量洗浄と還流が可能となり，WONは縮小し，治癒し得た。 |
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| AbstractList | 症例は70歳代，男性。アルコール性重症急性膵炎の診断で他病院に入院した。退院2ヵ月後に再度上腹部痛が出現し，貧血の増悪を認めたため当院に転院となった。腹部造影CT検査所見では，膵頭部に長径7cmのwalled-off necrosis（WON）と回結腸動脈領域に2.5cmの仮性動脈瘤を認め，血管塞栓術を施行した。経過中に右腎臓から腸腰筋にかけて長径13cmのWONの増大を認め，感染の合併を認めた。内視鏡的経消化管的アプローチが困難な部位であり，経皮経肝的ドレナージ術を施行した。ドレナージチューブのサイズアップと2本挿入することで生理食塩水による大量洗浄と還流が可能となり，WONは縮小し，治癒し得た。 A man in his seventies was hospitalized at a neighborhood hospital with severe acute alcoholic pancreatitis in May 2013. In July 2013, he was hospitalized again with upper abdominal pain and transferred to our hospital. Abdominal CT showed a 7-cm area of walled-off necrosis（WON）in the pancreas head, and an ileocolic artery pseudoaneurysm, 2.5 cm in diameter. He was treated by transcatheter arterial embolization. A repeat CT performed 23 days after admission revealed a 13-cm infected WON area extending from the right kidney to the iliopsoas muscle. Percutaneous transhepatic drainage using an enlarged drainage tubes was performed for the infected WON lesion. A third CT showed reduction in the size of the WON area after the treatment. 症例は70歳代，男性。アルコール性重症急性膵炎の診断で他病院に入院した。退院2ヵ月後に再度上腹部痛が出現し，貧血の増悪を認めたため当院に転院となった。腹部造影CT検査所見では，膵頭部に長径7cmのwalled-off necrosis（WON）と回結腸動脈領域に2.5cmの仮性動脈瘤を認め，血管塞栓術を施行した。経過中に右腎臓から腸腰筋にかけて長径13cmのWONの増大を認め，感染の合併を認めた。内視鏡的経消化管的アプローチが困難な部位であり，経皮経肝的ドレナージ術を施行した。ドレナージチューブのサイズアップと2本挿入することで生理食塩水による大量洗浄と還流が可能となり，WONは縮小し，治癒し得た。 |
| Author | 石井, 優 山宮, 知 野本, 朋宏 吉田, 仁 北村, 勝哉 |
| Author_FL | Yamamiya Akira Kitamura Katsuya Nomoto Tomohiro Ishii Yu Yoshida Hitoshi |
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| Copyright | 2014, Japanese Society for Abdominal Emargency Medicine |
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| DocumentTitleAlternate | A Case of Ileocolic Artery Pseudoaneurysm and Infected Walled-off Necrosis after Severe Acute Pancreatitis Successfully Treated by Transcatheter Arterial Embolization and Percutaneous Drainage |
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| References | 5) 急性膵炎診療ガイドライン2015改訂出版委員会編：急性膵炎診療ガイドライン2015．東京，金原出版株式会社，2015 6) Yamamoto N, Isayama H, Kawakami H, et al: Preliminary report on a new, fully covered, metal stent designed for the treatment of pancreatic fluid collections. Gastrointest Endosc 2013; 77: 809-814. 2) Imamura H, Irisawa A, Takagi T, et al: Two cases of pancreatic abscess associated with penetration to the gastrointestinal tract during treatment using endoscopic ultrasound-guided drainage. Fukusima J Med Sci 2007; 53: 39-49. 7) Mukai S, Itoi T, Moriyasu F: Interventional endoscopy for the treatment of pancreatic pseudocyst and walled-off necrosis（with video）. J Hepatobiliary Pancreat Sci 2014; 21: E75-85. 8) Gardner TB, Coelho-Prabhu N, Gordon SR, et al: Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series. Gastrointest Endosc 2011; 73: 718-726. 1) Banks PA, Bollen TL, Dervenis C, et al: Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111. 3) van Santvoort HC， Besselink MG， Bakker OJ, et al: A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010; 362: 1491-1502. 4) van Baal MC, van Santvoort HC, Bollen TL, et al: Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 2011; 98: 18-27. |
| References_xml | – reference: 2) Imamura H, Irisawa A, Takagi T, et al: Two cases of pancreatic abscess associated with penetration to the gastrointestinal tract during treatment using endoscopic ultrasound-guided drainage. Fukusima J Med Sci 2007; 53: 39-49. – reference: 5) 急性膵炎診療ガイドライン2015改訂出版委員会編：急性膵炎診療ガイドライン2015．東京，金原出版株式会社，2015． – reference: 6) Yamamoto N, Isayama H, Kawakami H, et al: Preliminary report on a new, fully covered, metal stent designed for the treatment of pancreatic fluid collections. Gastrointest Endosc 2013; 77: 809-814. – reference: 7) Mukai S, Itoi T, Moriyasu F: Interventional endoscopy for the treatment of pancreatic pseudocyst and walled-off necrosis（with video）. J Hepatobiliary Pancreat Sci 2014; 21: E75-85. – reference: 4) van Baal MC, van Santvoort HC, Bollen TL, et al: Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 2011; 98: 18-27. – reference: 1) Banks PA, Bollen TL, Dervenis C, et al: Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111. – reference: 3) van Santvoort HC， Besselink MG， Bakker OJ, et al: A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010; 362: 1491-1502. – reference: 8) Gardner TB, Coelho-Prabhu N, Gordon SR, et al: Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series. Gastrointest Endosc 2011; 73: 718-726. |
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| Snippet | 症例は70歳代，男性。アルコール性重症急性膵炎の診断で他病院に入院した。退院2ヵ月後に再度上腹部痛が出現し，貧血の増悪を認めたため当院に転院となった。腹部造影CT検査... A man in his seventies was hospitalized at a neighborhood hospital with severe acute alcoholic pancreatitis in May 2013. In July 2013, he was hospitalized... |
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| SubjectTerms | walled-off necrosis 回結腸仮性動脈瘤 経皮的ドレナージ 重症急性膵炎 |
| Title | 重症急性膵炎に合併した回結腸仮性動脈瘤と感染性walled-off necrosisに対して血管塞栓術と経皮的ドレナージで治癒し得た1例 |
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