Takahashi Koji, Ohyama Hiroshi, Mikata Rintaro, Nagashima Hiroki, Ohno Izumi, Takiguchi Yuichi, Kato Naoya
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan.
Department of Medical Oncology, Graduate School of Medicine, Chiba University, Japan.
J Rural Med. 2022 Jul;17(3):184-188. doi: 10.2185/jrm.2022-002. Epub 2022 Jul 1.
To describe the case of a patient with intraperitoneal bleeding from the gastroepiploic artery by endoscopic ultrasound who was successfully treated with transcatheter arterial coil embolization. An 87-year-old man was referred to our hospital for examination of a gallbladder tumor. Endoscopic ultrasonography was performed using an oblique-view echoendoscope. After the endoscopic ultrasound, the patient went into shock. Computed tomography revealed a huge intraperitoneal hematoma and an aneurysm in the right gastroepiploic artery that were not seen on previous computed tomography images. Thus, urgent catheter angiography was performed, which showed a pseudoaneurysm of the right gastroepiploic artery and extravasation of the contrast medium from the pseudoaneurysm. Transcatheter arterial coil embolization was subsequently performed, and the bleeding stopped. Thereafter, his hemodynamics stabilized and his general condition improved. The patient was discharged 22 days post-treatment with an uneventful course. Observation-only endoscopic ultrasound without invasive procedures can cause intraperitoneal bleeding due to a ruptured splanchnic artery. Thus, endoscopic ultrasonography should be performed more carefully in elderly patients.
描述一例经内镜超声检查发现胃网膜动脉腹腔内出血并经导管动脉弹簧圈栓塞成功治疗的患者病例。一名87岁男性因胆囊肿瘤检查被转诊至我院。使用斜视角超声内镜进行了内镜超声检查。内镜超声检查后，患者出现休克。计算机断层扫描显示腹腔内有巨大血肿以及右胃网膜动脉有动脉瘤，而之前的计算机断层扫描图像上未见这些情况。因此，紧急进行了导管血管造影，结果显示右胃网膜动脉假性动脉瘤以及造影剂从假性动脉瘤外渗。随后进行了经导管动脉弹簧圈栓塞，出血停止。此后，他的血流动力学稳定，一般状况改善。患者在治疗后22天出院，病程平稳。无创的单纯观察性内镜超声检查可能因内脏动脉破裂导致腹腔内出血。因此，对于老年患者，内镜超声检查应更加谨慎。
