Nakama Rakuhei, Izawa Yoshimitsu, Kujirai Dai, Yagami Toshiaki, Kono Isao, Tanimura Keiichi, Honda Masanori, Kase Kenichi, Lefor Alan Kawarai
Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi 321-0974, Japan.
Department of Radiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi 321-0974, Japan.
Radiol Case Rep. 2018 Nov 22;14(2):251-254. doi: 10.1016/j.radcr.2018.11.003. eCollection 2019 Feb.
Surgical treatment of mesenteric injuries is necessary to control hemorrhage, manage bowel injuries, and evaluate bowel perfusion. It has recently been suggested that some patients can be managed with transcatheter arterial embolization (TAE) for initial hemostasis. We present a hemodynamically unstable patient who was initially managed by TAE for traumatic mesenteric hemorrhage. A 60-year-old man was injured in a motor vehicle accident and transported to our facility. On arrival, the patient was hemodynamically stable, and had abdominal pain. Physical examination revealed a seatbelt sign on the lower abdomen. A contrast-enhanced computed tomography (CT) scan showed intra-abdominal hemorrhage, mesenteric hematoma, and a giant-pseudoaneurysm, but no intra-abdominal free air or changes in the appearance of the bowel wall. After the CT scan, his vital signs deteriorated and surgical intervention was considered, but TAE was performed to control the hemorrhage. After TAE, the patient was hemodynamically stable and had no abdominal tenderness. A follow-up CT scan was performed 2 days later which showed partial necrosis of the transverse colon and some free air. Resection of the injured transverse colon with primary anastomosis was performed. The patient improved and was discharged 35 days after injury. TAE can be effective as the initial hemostatic procedure in patients with traumatic mesenteric hemorrhage.
肠系膜损伤的手术治疗对于控制出血、处理肠损伤以及评估肠灌注是必要的。最近有人提出，一些患者可以通过经导管动脉栓塞术（TAE）进行初始止血治疗。我们报告一例血流动力学不稳定的患者，其因创伤性肠系膜出血最初接受了TAE治疗。一名60岁男性在机动车事故中受伤并被送往我院。入院时，患者血流动力学稳定，但有腹痛。体格检查发现下腹部有安全带征。增强计算机断层扫描（CT）显示腹腔内出血、肠系膜血肿和巨大假性动脉瘤，但无腹腔内游离气体或肠壁外观改变。CT扫描后，患者生命体征恶化，考虑进行手术干预，但实施了TAE以控制出血。TAE术后，患者血流动力学稳定，无腹部压痛。2天后进行了随访CT扫描，显示横结肠部分坏死并有一些游离气体。遂行受伤横结肠切除并一期吻合术。患者病情好转，受伤后35天出院。TAE作为创伤性肠系膜出血患者的初始止血方法可能有效。
