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福島医学会 = The Fukushima Society of Medical Science >
福島医学雑誌 = Fukushima Medical Journal >
Vol.73 (2023) >
Vol.73 No.1 (2023) >

Please use this identifier to cite or link to this item: http://ir.fmu.ac.jp/dspace/handle/123456789/1964

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Title: 腸管切除を行わずに救命し得た消化管アミロイドーシスに非閉塞性腸管虚血を併発した1例
Other Titles: A case of non-occlusive mesenteric ischemia complicated by intestinal amyloidosis that was saved without intestinal resection
Authors: 深井, 智司
早瀬, 傑
大関, 篤
丸山, 裕也
遠藤, 久仁
伊藤, 泰輔
石井, 芳正
河野, 浩二
Affiliation: 消化管外科学講座
Source title: 福島医学雑誌
Volume: 73
Issue: 1
Start page: 7
End page: 11
Issue Date: 2023
Abstract: 本邦では消化管アミロイドーシスと非閉塞性腸管虚血(non-occlusive mesenteric ischemia ;以下,NOMI と略記)の併発例が数例報告されており,消化管へのアミロイド沈着がNOMIの危険因子となる可能性が示唆されている。今回我々は,腸管切除を行わずに救命し得た消化管アミロイドーシスにNOMIを併発した1例を経験したため報告する。症例は81歳の男性で,吐血を主訴に当院に救急搬送された。来院時ショックバイタルを呈しており,腹部CT検査で腸管壁内ガス像,門脈ガス像を認めた。小腸壊死と診断し,緊急開腹手術を施行した。小腸,腸間膜にびまん性,非連続性の発赤を認めたが,全体的な腸管の色調や蠕動は良好であった。NOMIの所見として矛盾しないが不可逆的な腸管壊死には至っていないものと判断し,腸管切除は行わずに試験開腹のみで終了した。術後は体液管理行い,徐々に全身状態は改善を得,術後14日目に軽快退院した。退院後に下痢の訴えがあり,上部消化管内視鏡検査を施行したところ,胃および十二指腸の生検で消化管アミロイドーシスと診断され,NOMIと消化管アミロイドーシスの関連が疑われた。
Several cases of gastrointestinal amyloidosis and non-occlusive mesenteric ischemia (NOMI) have been reported in Japan, suggesting that amyloid deposition in the gastrointestinal tract can be a risk factor for the development of NOMI. We herein present a case of NOMI complicated by gastrointestinal amyloidosis which was treated without intestinal resection. The patient was an 81-yearold man who came to our hospital with a complaint of hematemesis. Blood pressure reductions were observed, and an abdominal CT scan showed gas in the intestinal wall and portal vein. A diagnosis of intestinal necrosis was made, and an emergency laparotomy was performed. The intestinal tract and mesentery were reddish, but the overall intestinal color and peristalsis were fine. Despite the diagnosis of NOMI, it was judged that irreversible intestinal necrosis had not yet occurred, and the operation was completed only by exploratory laparotomy without intestinal resection. Post-operatively, the patient was admitted to the ICU for circulatory management. His general condition gradually improved, and he was discharged on post-operative day 14 from the hospital. After discharge from hospital, the patient complained of diarrhea, and an upper gastrointestinal endoscopy was performed. A diagnosis of gastrointestinal amyloidosis was made based on findings from biopsies of the stomach and duodenum and association of NOMI and gastrointestinal amyloidosis was suspected.
Publisher: 福島医学会
language: jpn
URI: http://ir.fmu.ac.jp/dspace/handle/123456789/1964
Full text URL: http://ir.fmu.ac.jp/dspace/bitstream/123456789/1964/1/FksmMedJ_73_p7.pdf
ISSN: 0016-2582
DOI: 10.5387/fmedj.73.1_7
Related Page: https://doi.org/10.5387/fmedj.73.1_7
Rights: © 2023 福島医学会
Appears in Collections:Vol.73 No.1 (2023)

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