腹腔内出血の原因となった新生児副腎大量出血の治験例

概要

論文の詳細を見る
A two-day-old female infants was admitted with a diagnosis of hemoperitoneum due to birth trauma. The source of bleeding was thought to be the ruptured liver by abdominal scout films and an emergency laparotomy was carried out. A massive hemorrhage from the ruptured right adrenal gland was found in the peritoneal cavity. The adrenal gland was located to the right of the displaced ascending colon. The right kindney embedded in the hematoma appeared to be normal. The left retroperitoneal space including the left kidney was also normal by palpation. Because of extreme friability of the adrenal tissue, attempts of ligation of the bleeding vessels failed and right adrenalectomy was carried out. Postoperative course of the infant was complicated with lung edema due to excessive blood transfusion, consumption coagulopathy, candidiasis cutis, and post-transfusion hepatitis. However, she was well without evidence of adrenal insufficiency or calcification in the left adrenal gland at four months of age. Cause of massive adrenal hemorrhage in newborn cannot be single and physiological involution and necrosis of the fetal cortex in this period must be a trigger of the hemorrhage. Signs and symptoms as well as recently advanced diagnostic methods, indications of surgery and principles of treatment of massive adrenal hemorrhage in the newborn were reviewed and points of remarks were discussed.
特定非営利活動法人日本小児外科学会の論文
1980-06-20