Otsuka Hiroyuki, Fukushima Tomokazu, Tsubouchi Youhei, Sakurai Keiji, Inokuchi Sadaki
Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Kanagawa, Japan.
SAGE Open Med Case Rep. 2019 Jan 12;7:2050313X18824816. doi: 10.1177/2050313X18824816. eCollection 2019.
Despite rapid advancements in medical technologies, the use of interventional radiology in a patient with hemodynamic instability or hollow viscus injury remains controversial. Here, we discuss important aspects regarding the use of interventional radiology for such patients. A 74-year-old Japanese male climber was injured following a 10 m fall. On admission, his systolic blood pressure was 40 mmHg. He had disturbance of consciousness and mild upper abdominal pain without peritoneal irritation. Focused assessment sonography for trauma indicated massive hemorrhage in the intra-abdominal cavity. Plain radiographs revealed hemopneumothorax with right-side rib fractures. Thoracostomy to the right thoracic cavity and massive transfusion were immediately performed. Consequently, a sheath catheter was inserted into the common femoral artery for interventional radiology. His systolic blood pressure increased to 80 mmHg owing to rapid transfusion. In the computed tomography scan room, based on computed tomography findings, we judged that it was possible to achieve hemostasis by interventional radiology. The time from hospital admission to entering the angiography suite was 38 min. Transcatheter arterial embolization for hemorrhage control was performed without complications. Following transcatheter arterial embolization, he was admitted to the intensive care unit. All injuries could be treated conservatively without surgery. His post-interventional course was uneventful, and he recovered completely after rehabilitation. Hemorrhage control using interventional radiology should be assessed as a first-line treatment, even in hemodynamically unstable patients having a hollow viscus injury with active bleeding, without obvious findings that indicate surgical repair.
尽管医疗技术迅速发展，但在血流动力学不稳定或中空脏器损伤的患者中使用介入放射学仍存在争议。在此，我们讨论有关对此类患者使用介入放射学的重要方面。一名74岁的日本男性登山者在10米高处坠落受伤。入院时，他的收缩压为40毫米汞柱。他有意识障碍和轻度上腹部疼痛，但无腹膜刺激征。创伤重点超声检查显示腹腔内大量出血。X线平片显示右侧血气胸伴右侧肋骨骨折。立即对右侧胸腔进行胸腔闭式引流并大量输血。随后，经股总动脉插入鞘管用于介入放射学检查。由于快速输血，他的收缩压升至80毫米汞柱。在计算机断层扫描室，根据计算机断层扫描结果，我们判断通过介入放射学有可能实现止血。从入院到进入血管造影室的时间为38分钟。进行了经导管动脉栓塞术以控制出血，无并发症发生。经导管动脉栓塞术后，他被收入重症监护病房。所有损伤均无需手术即可保守治疗。他介入治疗后的病程平稳，康复后完全康复。即使在有中空脏器损伤且有活动性出血、无明显手术修复指征的血流动力学不稳定患者中，使用介入放射学控制出血也应被视为一线治疗方法。
