Ikeda Mitsunori, Kitai Toshihiro, Hayashi Nobuhiro, Ukai Isao, Nobunaga Toshikatsu, Kohno Masanobu, Sugino Tatsuya
Department of Emergency and Critical Care Center, Hyogo Prefectural Nishinomiya Hospital, 13-9 Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
Department of Obstetrics and Gynecology, Hyogo Prefectural Nishinomiya Hospital, 13-9 Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
JA Clin Rep. 2019 Jul 20;5(1):48. doi: 10.1186/s40981-019-0266-6.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) can control massive postpartum hemorrhage.
A 41-year-old woman transferred to hospital following cesarean section presented in refractory hemorrhagic shock. REBOA was blindly performed in the emergency department. She immediately underwent hysterectomy and damage control surgery in the operating room. The aortic balloon, whose position was confirmed at zone II by postoperative X-ray, provided intermittent occlusion for 40 min during surgery. Hemodynamics were stabilized with these interventions, with massive transfusion required for severe coagulopathy perioperatively. She gradually recovered with intensive care but suffered ascending colon ischemia with perforation on day 16. She received a colostomy and was discharged without sequelae after 130 days. Amniotic fluid embolism was diagnosed according to clinical criteria and supplemental serum markers.
This patient suffered colonic ischemia possibly due to REBOA used to manage amniotic fluid embolism. REBOA requires careful consideration to avoid complications.
主动脉内复苏球囊阻断术（REBOA）可控制产后大出血。
一名41岁女性剖宫产术后转入我院，出现难治性失血性休克。在急诊科盲目实施了REBOA。她随即在手术室接受了子宫切除术和损伤控制手术。术后X线证实主动脉球囊位于II区，术中提供了40分钟的间歇性阻断。通过这些干预措施血流动力学得以稳定，围手术期因严重凝血功能障碍需要大量输血。她在重症监护下逐渐康复，但在第16天出现升结肠缺血伴穿孔。她接受了结肠造口术，130天后出院，无后遗症。根据临床标准和补充血清标志物诊断为羊水栓塞。
该患者可能因使用REBOA治疗羊水栓塞而发生结肠缺血。REBOA需要谨慎考虑以避免并发症。
