腸瘻造設後に血便で発見された下腹壁動脈損傷の1例(A case of inferior epigastric artery injury found in bloody stool after intestinal fistula construction)

• Published in: Nihon Kyūkyū Igakkai zasshi 2021-08, Vol.32 (8), p.427-430
• Main Authors: (Keita Sato), 佐藤 啓太, (Jyunji Uraki), 浦城 淳二, (Toshiki Matsui), 松井 俊樹, (Yoshihisa Tamura), 田村 佳久, (Yosuke Yamauchi), 山内 洋介, (Koji Takahashi), 高橋 幸二, (Tsukasa Kusuta), 楠田 司
• Format: Article
• Language: English
• Subjects: gastrointestinal bleeding; interventional radiology (IVR); intestinal fistula; インターベンショナルラジオロジー; 消化管出血; 腸瘻カテーテル
• ISSN: 1883-3772; 1883-3772
• DOI: 10.1002/jja2.12618

要旨 症例は86歳の男性。癒着に伴う絞扼性腸閉塞に対して小腸切除術および空腸に腸瘻造設術を行った。術後6日目に貧血の進行と血便を認めた。消化管出血が原因と考えたが，精査の結果，腸瘻カテーテルの腹壁貫通路に存在する左下腹壁動脈末梢の損傷による出血と診断した。腹直筋筋膜下の出血であり，interventional radiology（IVR）によって左下腹壁動脈を塞栓して止血を得た。血便という非常に稀な臨床所見で発見した腸瘻カテーテル関連の合併症であり，とくに左右下腹部を貫通させて造設した後の消化管出血の際には鑑別に挙げる必要がある。また，止血の際には局所麻酔下で出血点に到達できるIVRが有用と考えられた。 ABSTRACT The patient in this case study is an 86–year–old man. We performed partial resection of the jejunum and jejunostomy for treatment of strangulation ileus. Six days after undergoing the operation, he had bloody stools and progression of anemia. Upon close examination, the diagnosis was determind to be bleeding from injury to the left inferior epigastric artery in the abdominal wall, which was penetrated by part of the enteral feeding tube. Subfascial hemorrhage occurred, and hemostasis was obtained by embolizing the left inferior epigastric artery by interventional radiology (IVR). This case describes a feeding tube–related complication discovered in an extremely rare clinical finding, and it is necessary to distinguish it from cases of gastrointestinal bleeding from penetration of the left and right lower abdomen after jejunostomy. Furthermore, an IVR procedure that is able to reach a hemorrhagic site with the patient under just only local anesthesia is very useful for performing hemostasis.