食道静脈瘤の硬化療法後に直腸静脈瘤破裂による大量出血で死亡した1剖検例

概要

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A 54-year-old man with liver cirrhosis was admitted to the Kitasato University East Hospital with chief complaints of facial edema and oliguria. He had received sclerotherapy several times for gastroesophageal varices associated with portal hypertension. On the second hospital day, massive hemorrhaging suddenly occurred from the anorectal area. By anorectal fiberscopic examination, a large racemose varicose mass was found protruding at the lower end of the rectum. Profuse bleeding continued until surgical suture and intensive screlotherapy were done. The next day the patient died of disseminated intravascular coagulation (DIC) accompanied by multiple organ failure. Autospy showed advanced liver cirrhosis and various evidence of marked portal hypertension. On injection of barium sulphate gelatin solution, abnormally large anorectal varices and moderate gastroesophageal varices showed up in the gastrointestinal tract. The main cause of death was ascribed to massive bleeding from ruptured anorectal varices. This case demonstrates that in the management of gastroesophageal varices by sclerotherapy the possibility of ectopic verices, especially anorectal varices, is clinically important.
北里大学の論文
1992-02-29