Hiraki Sakiko, Sato Fumie, Okada Ichiro, Osugi Masaya, Watanabe Yoshiya, Ichinose Yoshiaki
Department of Radiology, National Hospital Organization Disaster Medical Center, 3256, Midoricho, Tachikawa, Tokyo, 190-0014, Japan.
Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan.
Radiol Case Rep. 2023 Jun 21;18(9):3026-3031. doi: 10.1016/j.radcr.2023.06.020. eCollection 2023 Sep.
A 44-year-old man with chronic idiopathic pseudo-intestinal obstruction and lumbar disc herniation presented with orthostatic dizziness, black vomiting, and stools. He was suspected to have an ulcer caused by nonsteroidal anti-inflammatory drugs and treated conservatively but continued to have transfusion-dependent anemia. Trans-arterial contrast-enhanced computed tomography showed multiple microbleeds in the small intestine. We diffusely embolized 7 small intestine branches of the superior mesenteric artery using imipenem/cilastatin on 2 separate occasions. This stopped the bleeding, and the patient progressed well without ischemic complications and was discharged on the 25th postoperative day. Transcatheter arterial embolization with imipenem/cilastatin may be a viable treatment option for patients with multiple small bowel bleeds in a large area of the small intestine that are unresponsive to conservative treatment or endoscopic methods.
一名患有慢性特发性假性肠梗阻和腰椎间盘突出症的44岁男性出现体位性头晕、黑色呕吐物和黑便。他被怀疑患有非甾体抗炎药引起的溃疡,并接受了保守治疗,但仍持续存在依赖输血的贫血。经动脉对比增强计算机断层扫描显示小肠有多处微出血。我们在两个不同的时间使用亚胺培南/西司他丁对肠系膜上动脉的7个小肠分支进行了弥漫性栓塞。出血停止,患者恢复良好,无缺血性并发症,术后第25天出院。对于小肠大面积多处出血且对保守治疗或内镜方法无反应的患者,经导管动脉内注入亚胺培南/西司他丁栓塞术可能是一种可行的治疗选择。