Osaka Kimito, Kobayashi Masataka, Takano Tetsuzou, Tsuchiya Futoshi, Iwasaki Akira, Endo Hideho
Department of Urology, Yokohama City Minato Red Cross Hospital.
Hinyokika Kiyo. 2009 May;55(5):263-6.
A 21-year-old man was brought to our hospital for a single stab wound in the left flank inflicted with a suicidal intent. The initial computed tomographic (CT) scan of the patient with hypotension revealed a perirenal hematoma. Laparotomy was carried out in order to rule out any wounds of intra-abdominal organs. There was no active bleeding in any intraperitoneal organs, but a stab wound in the left renal lower pole, 2 cm in length, was recognized and considered as the cause of the hematoma. Therefore, the wound of the renal parenchyma, which was accompanied by neither urinary leakage nor fresh bleeding, was closed. The patient received a blood transfusion, because gross hematuria appeared three days postoperatively and severe anemia ensued. Then, enhanced CT scan revealed a left intrarenal pseudoaneurysm. By the following arterial angiography the renal pseudoaneurysm with arteriovenous fistula was confirmed and successfully occluded using selective arterial embolization twice. Transcatheter arterial embolization is considered safe and effective and should be chosen as a first-line therapy for controlling hemorrhage from renal arterial pseudoaneurysms.
一名21岁男性因意图自杀用刀刺伤左腰侧被送至我院。对伴有低血压的患者进行的首次计算机断层扫描(CT)显示肾周血肿。为排除腹腔内器官的任何伤口,进行了剖腹手术。腹腔内任何器官均无活动性出血,但发现左肾下极有一处2厘米长的刺伤,认为这是血肿的原因。因此,对未伴有尿液渗漏和新鲜出血的肾实质伤口进行了缝合。患者接受了输血治疗,因为术后三天出现肉眼血尿并继而出现严重贫血。随后,增强CT扫描显示左肾内假性动脉瘤。通过随后的动脉血管造影证实了伴有动静脉瘘的肾假性动脉瘤,并使用选择性动脉栓塞术成功进行了两次封堵。经导管动脉栓塞术被认为是安全有效的,应作为控制肾动脉假性动脉瘤出血的一线治疗方法。