腸壊死の術後に発症した敗血症,DICに交換輸血が奏効した1,700g未熟児症例

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A four-day-old male infant was admitted lo Kanazawa Medical Univ. Hospital with a history of vomiting, abdominal detention, and hematochezia of four days duration. His birth weight was 1,700gm. Roentgenologically, volvulus of small intestine was suspected and the emergent laparotomy was performed. Upon opening the peritoneum, twisted ileum with necrosis which was adherent to parietal peritoneum just bihind the umbilicus was exposed. As intestinal viability was not recovered after release of the torsion, 9cm length of the ileum was resected and end to end anastomosis was performed. At this time, there were leukocytopenia (3,400/mm^2) and thrombocytopenia (89,000/mm^2). Because septicemia due to Gram-negative microorganism was suggested, exchange transfusion with citrated fresh whole blood was performed in addition to antibiotics, plasma volume expander, and vasoactive drug. The blood culture yielded Pseudomonas cepacia for succeeding two months. Although no bleeding tendency was observed during the whole course, fibrinogen measured 88mg/dl and FDP above 40μg/ml. Exchange transfusion was repeated up to five times and the laboratory data such as platelet count, white blood cell count, fibrinogen, and FDP showed improvement twenty days after the institution of the therapy, and the patient ultimately survived. There was no complication of exchange transfusion in our case. Serial laboratory examination is helpful for the early diagnosis of septicemia and/or DIC in especially premature infants after surgery. Our experience suggests that exchange transfusion decreases the mortality of surgically critical premature infants. It is important that when septicemia and/or DIC are suspected even if clinical signs and symptoms are minimal, therapy with antibiotics and exchange transfusion of early stage should performed.
日本小児外科学会の論文
1984-04-20

腸壊死の術後に発症した敗血症,DICに交換輸血が奏効した1,700g未熟児症例

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