Hamanaka Kunio, Hirokawa Yuusuke, Itoh Tsuyoshi, Fujino Mitsuhiro, Kano Kenichi, Beppu Satoru, Sasahashi Nozomu, Nishiyama Kei
Department of Emergency and Critical Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan.
Department of Radiology National Hospital Organization Kyoto Medical Center Kyoto Japan.
Acute Med Surg. 2016 Nov 10;4(2):205-208. doi: 10.1002/ams2.247. eCollection 2017 Apr.
A 52-year-old woman was admitted to our hospital with hypotension after falling from the fifth floor of an apartment building. Contrast-enhanced computed tomography showed liver injury with extravasation of contrast material from the hepatic artery, and extrahepatic portal venous injury with extravasation and pseudoaneurysm. Intra-abdominal hemorrhage was not observed, and bleeding was confined to the retroperitoneal space. Hepatic arteriography showed extravasation, while portal venography showed pseudoaneurysm but no extravasation. After transarterial embolization, the patient's vital signs improved. Non-operative management was selected for the portal venous injury.
Computed tomography on the 58th hospital day revealed disappearance of the portal venous pseudoaneurysm. The patient was discharged on the 90th hospital day without any complications.
This case shows that non-operative management can be selected for portal venous injury when there is no retroperitoneal injury and bleeding is confined to the retroperitoneal space.
一名52岁女性从公寓楼五楼坠落，因低血压被送入我院。增强计算机断层扫描显示肝脏损伤，有造影剂从肝动脉外渗，肝外门静脉损伤伴外渗和假性动脉瘤形成。未观察到腹腔内出血，出血局限于腹膜后间隙。肝动脉造影显示有外渗，而门静脉造影显示有假性动脉瘤但无外渗。经动脉栓塞后，患者生命体征改善。门静脉损伤选择非手术治疗。
住院第58天的计算机断层扫描显示门静脉假性动脉瘤消失。患者于住院第90天出院，无任何并发症。
该病例表明，当不存在腹膜后损伤且出血局限于腹膜后间隙时，门静脉损伤可选择非手术治疗。
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