肝嚢胞感染症に対する超音波ガイド下経皮カテーテルドレナージ後の内乳腺動脈損傷による遅発性出血合併症

Delayed bleeding complication due to internal mammary artery injury after ultrasound-guided percutaneous catheter drainage for liver cyst infection.

• Tomoyuki Arai
• Shinichiro Masuda
• Tomotsugu Nakano
• Rintaro Hojo
• Takaaki Tsuchiyama
• Seiji Fukamizu
• Takashi Shibui

抄録

背景:

超音波ガイド下経皮カテーテルドレナージ（PCD）は、化膿性肝膿瘍の一次治療として広く受け入れられている。PCDに関連した重篤な合併症が報告されているが、乳腺動脈損傷による遅発性出血の合併症は不明である。

Background: Ultrasound-guided percutaneous catheter drainage (PCD) is widely accepted as a primary treatment for pyogenic liver abscess. Severe PCD-related complications have been reported; however, delayed bleeding complications due to internal mammary artery injury are unknown.

症例紹介:

局所性分節性糸球体硬化症による慢性腎臓病で血液透析を受けている84歳男性が肝嚢胞感染症で当院に入院した。超音波ガイド下PCDは正常な肝臓を上腹部正中線、第6肋間のレベルで行った。2日後に穿刺部位に腹部血腫が発生した．造影CT検査で右内乳腺遠位動脈の滲出を認め，経皮的コイル塞栓術で治療に成功した．

Case Presentation: An 84-year-old man undergoing hemodialysis owing to chronic kidney disease due to focal segmental glomerulosclerosis was admitted to our hospital for liver cyst infection. Ultrasound-guided PCD was carried out through the normal liver at the upper abdominal midline at the level of the sixth intercostal space. Two days later, an abdominal hematoma occurred at the puncture site. Contrast-enhanced computed tomography revealed extravasation of the distal right internal mammary artery, which was successfully treated with percutaneous coil embolization.

結論:

PCD後に血腫が進行した場合、鑑別診断として乳腺動脈内損傷を考慮すべきである。

Conclusion: Internal mammary artery injury should be considered as a differential diagnosis when a progressing hematoma develops after PCD.

© 2020 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.