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외상 후 단독 상장간막동맥박리 후에 국소적으로 진행된 박리성 동맥류와 심한 진강의 압박이 있는 환자에서 혈관내 스텐트설치술 1례
김영규 ( Young Kyu Kim ),허규희 ( Kyu Hee Her ),김승형 ( Seung Hyoung Kim ),김광식 ( Kwangsik Kim ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.4
Reports on a posttraumatic isolated superior mesenteric artery (SMA) dissection are rare. Recently, endovascular stent placement via percutaneous access, instead of vascular surgery, has been widely accepted as the initial treatment for a patient with an isolated SMA dissection or its complications. A 60-year-old female patient was transferred to our hospital due to an isolated SMA dissection after a car accident. The SMA dissection was 8.5 cm in length, and it involved the true lumen, which was severely compressed by the thrombosed false lumen. The patient was closely observed because she did not complain of any specific visceral pain. On the seventh hospital day, she underwent computed tomography (CT) to decide on a further treatment plan, irrespective of the presence of the abdominal symptom. The findings of the follow-up CT showed no difference compared to those of the previous CT. She was discharged with anticoagulants. One month later, the follow-up CT revealed focally progressing dissecting aneurysms in the false lumen of the dissected SMA and a more severely compressed true lumen. Two self-expandable metallic stents were successfully placed in the true lumen of the dissected SMA, covering two aneurysmal lesions. Herein, we report a successful endovascular treatment with stent placement for treating focally progressing dissecting aneurysms and a severely compressed true lumen in a patient with a posttraumatic isolated SMA dissection. [ J Trauma Inj 2015; 28: 266-271 ]
알코올성 간경화증에 동반된 상행 결장의 정맥류 출혈 1예
김흥업 ( Heung Up Kim ),허규희 ( Kyu Hee Her ),김승형 ( Seung Hyoung Kim ),김봉수 ( Bong Soo Kim ),강영준 ( Young Joon Kang ),이재천 ( Jae Chun Lee ),김광식 ( Kwang Sik Kim ) 대한내과학회 2008 대한내과학회지 Vol.75 No.2
간경변증이나 문맥 고혈압에 의한 정맥류 출혈은 주로 식도와 위에 발생하나 일부에서는 소장과 대장 등에서도 발생할 수 있다. 대장의 정맥류 출혈은 주로 직장과 맹장에 발생하며 국내에서는 좌측 대장에 발생된 소수의 예만 보고되었고, 아직 상행 결장의 정맥류 출혈은 보고된 바 없다. 알코올성 간경변증으로 의심되는 43세 남자 환자가 대량의 혈변으로 내원하였고, 복부 전산화단층촬영 및 혈관조영술로 상행 결장의 정맥류를 확인하고 우 결장반절제술을 시행하였고, 수술 후 지혈되었으며 수술 검체에서 정맥류에 의한 출혈이 확인되었다. 저자는 43세 남자 환자에서 발생한 알코올성 간경화증에 의한 상행 결장의 정맥류 출혈을 문헌고찰과 함께 보고하는 바이다. We report a very rare case of colonic varix with massive bleeding. A 43-year-old male patient was transferred to our hospital for hematochezia. The patient had a history of chronic liver disease associated with alcohol use. The initial blood pressure was 93/73 mmHg, and the hemoglobin level was 8.4 g/dL. Severe hepatomegaly and periportal fatty infiltration were seen on abdominal computed tomography. Markedly ectatic veins protruded from the luminal side of the proximal ascending colon and drained to the dilated ileocecal and retroperitoneal veins. Emergent colonoscopy failed because of continuous hematochezia and hypovolemic shock, despite massive transfusion. Markedly dilated colonic varices were noticed around the ileocecal and ascending colon on superior mesenteric arteriography. An emergent right hemicolectomy was performed. The presumed bleeding focus was a protruding varix with a red clot on the top of a denuded vein on the anteromedial wall of the proximal ascending colon. (Korean J Med 75:215-220, 2008)