術中血管造影用カテーテルを用いた色素注入により至適切除範囲を決定し得た小腸angiodysplasiaの1例

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We report a case of angiodysplasia of the small intestine in a 72-year-oldwoman frequently admitted to the Department of Gastroenterology in our hospitalcomplaining of gastrointestinal bleeding of unknown origin since September 2000.She had massive gastrointestinal bleeding on April 22, 2002. Angiography revealedextravasation from a peripheral region of the fourth branch of the jejunal artery withearly venous pattern which was diagnosed as angiodysplasia. The angiographic catheterwas kept inserted for intraoperatively. She entered shock status and underwentemergency surgery. During the operation, we could not find the fourth point accuratelyby inspection and palpation, and so injected indocyaningreen via the angiographiccatheter to identify the optimal surgical range. The stained part of the jejunum wasresected inthelengthof50crn.The resected specimen revealed the pin-hole like bleeding point. Pathologicalexamination showed characteristic features of a submucosal angiodysplasia in the 20cm1ength of the jejunum.We conclude that intraoperative dye injection with the angiographic catheter is thereasonable method to identify the optimal surgical range in patients with small bowelhemorrhage.
奈良医学会の論文
2004-04-30