出血性ショックを来した,横行結腸海綿状血管腫に上腸間膜動脈分枝動脈瘤破裂を併発した1例

大腸海綿状血管腫は稀な疾患である.また上腸間膜動脈分枝動脈瘤破裂もきわめて稀である.最近われわれは,24歳男性で,突然の上腹部痛で発症し緊急手術により,横行結腸海綿状血管腫よりの腹腔内出血を認め同部を切除した.術後,再度の腹腔内出血に対し,血管造影を施行し,上腸間膜動脈第1空腸枝動脈瘤と診断し,動脈瘤結紮切除を行った症例を経験した.大腸海綿状血管腫は本邦では過去に53例,欧米では300例を越える報告があるが,それが原因で腹腔内出血を来した症例は極めてめずらしい.また上腸間膜動脈分枝動脈瘤も世界で40例の報告があるにすぎず,極めて稀な疾患である.Cavernous hemangioma of the colon is a rare disease, and superior mesenteric artery branch aneurysm is even rarer. We recently performed emergency surgery on a 24-year-old man with sudden epigastralgia, during which an intraabdominal hemorrhage caused by cavernous hemangioma of the transverse colon was detected. Following surgery, the patient suffered another intraabdominal hemorrhage, and angiography confirmed a superior mesenteric artery first jejunum branch aneurysm, resulting in another operation. To date, 53 cases of cavernous hemangioma of the colon have been documented in Japan, and over 300 cases in Europe and America. However, intraabdominal hemorrhage coused by colon cavernous hemangioma is very rare. In addition, there have been 40 documented cases of superior mesenteric artery branch aneurysm worldwide, however, none of these cases occurred in Japan

頚部大血管損傷に対する治療上の問題点について

An injury to major blood vessels in the neck is a special kind of injury whose prognosis is dependent on the outcome of the initial treatment following first-aid given immediately after the injury. In this study, the basic knowledge of such injury and procedures for its treatment with which traumatologists should be equipped are discussed including referenses to the relevant literature. Out of the 73 cases of neck injuries at our center in 15 years, 13 cases were major blood vessel injuries of which 3 cases resulted in deaths (23%). Among the suvivors, one case where the internal carotid artery was occluded with ligature had a complication of transient hemiplegia and headache. The first choice procedure for injuried blood vessels seemed to be suturing and, when possible, ligation for the common carotid artery; suturing, without ligation as far as possible, for the internal carotid artery; and ligation for the external carotid artery and internal or external juglar vein. For life-saving purposes, it seemed preferable to occulde the vessel with ligature, without over regard to suturing. Also, in the injury of an artery, it seemed an effective procedure in faciliting the observation and treatment of an injured site to make a new incision on the posterior side to expose the common carotid artery and block the flow of blood temporarily

An Autopsied Case of Malignant Sarcomatoid Pleural Mesothelioma in Which Chest Pain Developed Several Months Earlier without Abnormality on Imaging

The patient experienced chest pain for about 7 months, but a diagnosis could not be made until after death. He was diagnosed with malignant sarcomatoid pleural mesothelioma on autopsy. In this case report, difficult aspects of the diagnosis are discussed. The 70-year-old Japanese man was a driver who transported ceramic-related products. Right chest pain developed in July 2013, but no abnormality was detected on a chest computed tomography (CT) performed in September 2013, and the pain was managed as right intercostal neuralgia. A chest CT performed in late October 2013 revealed a right pleural effusion, and the patient was referred to our hospital in early November 2013. Thoracentesis was performed, but the cytology was negative, and no diagnosis could be made. Close examination was postponed because the patient developed a subarachnoid hemorrhage. He underwent 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) after discharge from the neurosurgery department, and extensive right pleural thickening and 18F-FDG accumulation in this region were observed. Based on these findings, malignant pleural mesothelioma was suspected, and a thoracoscopy was performed under local anesthesia in early December 2013, but no definite diagnosis could be made. The patient selected best supportive care and died about 7 months after the initial development of right chest pain. The disease was definitively diagnosed as malignant sarcomatoid pleural mesothelioma by a pathological autopsy. When chronic chest pain of unknown cause is observed and past exposure to asbestos is suspected, actions to prevent delay in diagnosis should be taken, including testing for suspicion of malignant pleural mesothelioma