腹腔鏡下結腸切除後に発症した上・下腸間膜静脈・門脈血栓症の1例
腹腔鏡下大腸切除後に上腸間膜静脈・下腸間膜静脈・門脈に血栓症を合併した1例を経験したので報告する．症例は68歳女性の盲腸・S状結腸二重癌で腹腔鏡下に回盲部・S状結腸同時切除を行った．発熱と腹痛のため術後6日目に造影CT検査を施行したところ，上腸間膜静脈・下腸間膜静脈・門脈右枝に血栓形成を疑う所見を認めた．腸管うっ血の所見は認めなかった．絶食・抗生剤とヘパリン投与にて経過観察したところ軽快し，術後11日目に食事を再開した．14日目の再検CTにて血栓の増大を認めたが，無症状であるためワーファリン内服に変更し外来経過観察とした．術後78日目には検査上血栓は消失した．術後99日目のCT検査では上腸間膜...
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| Published in | 日本臨床外科学会雑誌 Vol. 71; no. 10; pp. 2644 - 2649 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2010
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.71.2644 |
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| Abstract | 腹腔鏡下大腸切除後に上腸間膜静脈・下腸間膜静脈・門脈に血栓症を合併した1例を経験したので報告する．症例は68歳女性の盲腸・S状結腸二重癌で腹腔鏡下に回盲部・S状結腸同時切除を行った．発熱と腹痛のため術後6日目に造影CT検査を施行したところ，上腸間膜静脈・下腸間膜静脈・門脈右枝に血栓形成を疑う所見を認めた．腸管うっ血の所見は認めなかった．絶食・抗生剤とヘパリン投与にて経過観察したところ軽快し，術後11日目に食事を再開した．14日目の再検CTにて血栓の増大を認めたが，無症状であるためワーファリン内服に変更し外来経過観察とした．術後78日目には検査上血栓は消失した．術後99日目のCT検査では上腸間膜静脈の空腸枝分岐部末梢と下腸間膜静脈が虚脱し，空調枝が代償性に拡張していた．明らかな原因は不明であったが，辺縁静脈を介した血行が良好であったため，うっ血や肝障害をきたさなかったものと考えられた． |
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| AbstractList | 腹腔鏡下大腸切除後に上腸間膜静脈・下腸間膜静脈・門脈に血栓症を合併した1例を経験したので報告する．症例は68歳女性の盲腸・S状結腸二重癌で腹腔鏡下に回盲部・S状結腸同時切除を行った．発熱と腹痛のため術後6日目に造影CT検査を施行したところ，上腸間膜静脈・下腸間膜静脈・門脈右枝に血栓形成を疑う所見を認めた．腸管うっ血の所見は認めなかった．絶食・抗生剤とヘパリン投与にて経過観察したところ軽快し，術後11日目に食事を再開した．14日目の再検CTにて血栓の増大を認めたが，無症状であるためワーファリン内服に変更し外来経過観察とした．術後78日目には検査上血栓は消失した．術後99日目のCT検査では上腸間膜静脈の空腸枝分岐部末梢と下腸間膜静脈が虚脱し，空調枝が代償性に拡張していた．明らかな原因は不明であったが，辺縁静脈を介した血行が良好であったため，うっ血や肝障害をきたさなかったものと考えられた． |
| Author | 池田, 純 糸川, 嘉樹 小出, 一真 園田, 寛道 塩飽, 保博 谷口, 史洋 |
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| References | 7) Mijnhout GS, Klinkenberg EC, Lycklama G, et al : Sepsis and elevated liver enzymes in a patient with inflammatory bowel disease : think of portal vein thrombosis. Dig Liver Dis 2004 ; 36 : 296-300 12) Denninger MH, Chait Y, Casadevail N, et al : Cause of portal or hepatic venous thrombosis in adults : the role of multiple concurrent factors. Hepatology 2000 ; 31 : 587-591 18) Schafer M, Krahenduhl L : Effect of laparoscopy on intra-abdominal blood flow. Surgery 2001 ; 129 : 385-389 22) Gutt CN, Schmedt CG, Schmandra T, et al : Insufflation profile and body position influence portal venous blood flow during pneumoperitoneum. Surg Endosc 2003 ; 17 : 1951-1957 6) Millan M, Hull TL, Hammel J, et al : Portal vein thrombi after restorative proctocolectomy : serious complication without long-term sequelae. Dis Colon Rectum 2007 ; 50 : 1540-1544 16) Odeberg S, Ljungqvist O, Sollevi A : Pneumoperitoneum for laparoscopic cholecystectomy is not associated with compromised splanchnic circulation. Eur J Surg 1998 ; 164 : 843-848 15) Jakimowicz J, Stultiens G, Smulders F : Laparoscopic insufflations of the abdomen reduces portal venous flow. Surg Endosc 1998 ; 12 : 427-431 1) Poultsides GA, Lewis WC, Feld R, et al : Portal vein thrombosis after laparoscopic colectomy : thrombolytic therapy via the superior mesenteric vein. Am Surg 2005 ; 71 : 856-860 9) Remzi FH, Fazio VW, Oncel M, et al : Portal vein thrombi after restorative proctocolectomy. Surgery 2002 ; 132 : 655-662 2) Baixauli J, Delaney CP, Senagore AJ, et al : Portal vein thrombosis after laparoscopic sigmoid colectomy for diverticulitis : report of a case. Dis Colon Rectum 2003 ; 46 : 550-553 3) Millikan KW, Szczerba SM, Dominguez JM, et al : Superior mesenteric and portal vein thrombosis following laparoscopic-assisted right hemicolectomy. Report of a case. Dis Colon Rectum 1996 ; 39 : 1171-1175 20) Schmandra TC, Kim ZG, Gutt CN : Effect of insufflations gas and intraabdominal pressure on portal venous flow during pneumoperitoneum in the rat. Surg Endosc 2001 ; 15 : 405-408 5) Okada T, Sasaki F, Minagawa N, et al : Postoperative portal and splenic vein thrombosis in children : identification of risk factors. Pediatr Surg Int 2005 ; 21 : 918-921 14) James AW, Rabl C, Westphalen AC, et al : Portomesenteric venous thrombosis after laparoscopic surgery : a systematic literature review. Arch Surg 2009 ; 144 : 520-526 19) Ho HS, Saunders CJ, Gunther RA, et al : Effector of hemodynamics during laparoscopy : CO2 absorption or intra-abdominal pressure? J Surg Res 1995 ; 59 : 497-503 8) Fichera A, Cicchiello LA, Mendelson DS, et al : Superior mesenteric vein thrombosis after colectomy for inflammatory bowel disease : a not uncommon cause of postoperative acute abdominal pain. Dis Colon Rectum 2003 ; 46 : 643-648 4) 新田泰樹，須井健太，仁熊健文他:腹腔鏡下大腸切除後に門脈塞栓症を合併した1例．日内視鏡外会誌 2007;12:514 17) Takagi S : Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy. Surg Endosc 1998 ; 12 : 427-431 10) Swartz DE, Felix EL : Acute mesenteric venous thrombosis following laparoscopic RouX-en-Y gastric bypass.JSLS 2004 ; 8 : 165-169 13) Rosendaal FR : Venous thrombosis : a multicausal disease. Lancet 1999 ; 353 : 1167-1173 21) Epstein RM, Wheeler HO, Frumin MJ, et al : The effect of hypercapnia on estimated hepatic blood flow, circulating splanchnic blood volume, and hepatic sulfobromophthalein clearance during beneral anesthesia in man. J Clin Invest 1961 ; 40 : 592-598 11) Bradbury MS, Kavanagh PV, Bechtold BE, et al : Mesenteric venous thrombosis : diagnosis and noninvasive imaging. Radiographics 2002 ; 22 : 527-541 23) Junghans T, Bohm B, Grundel K, et al : Does pneumoperitoneum with different gases, body positions, and intraperitoneal pressures influence renal and hepatic blood flow? Surgery 1997 ; 121 : 206-211 |
| References_xml | – reference: 19) Ho HS, Saunders CJ, Gunther RA, et al : Effector of hemodynamics during laparoscopy : CO2 absorption or intra-abdominal pressure? J Surg Res 1995 ; 59 : 497-503 – reference: 4) 新田泰樹，須井健太，仁熊健文他:腹腔鏡下大腸切除後に門脈塞栓症を合併した1例．日内視鏡外会誌 2007;12:514 – reference: 2) Baixauli J, Delaney CP, Senagore AJ, et al : Portal vein thrombosis after laparoscopic sigmoid colectomy for diverticulitis : report of a case. Dis Colon Rectum 2003 ; 46 : 550-553 – reference: 9) Remzi FH, Fazio VW, Oncel M, et al : Portal vein thrombi after restorative proctocolectomy. Surgery 2002 ; 132 : 655-662 – reference: 14) James AW, Rabl C, Westphalen AC, et al : Portomesenteric venous thrombosis after laparoscopic surgery : a systematic literature review. Arch Surg 2009 ; 144 : 520-526 – reference: 18) Schafer M, Krahenduhl L : Effect of laparoscopy on intra-abdominal blood flow. Surgery 2001 ; 129 : 385-389 – reference: 23) Junghans T, Bohm B, Grundel K, et al : Does pneumoperitoneum with different gases, body positions, and intraperitoneal pressures influence renal and hepatic blood flow? Surgery 1997 ; 121 : 206-211 – reference: 22) Gutt CN, Schmedt CG, Schmandra T, et al : Insufflation profile and body position influence portal venous blood flow during pneumoperitoneum. Surg Endosc 2003 ; 17 : 1951-1957 – reference: 6) Millan M, Hull TL, Hammel J, et al : Portal vein thrombi after restorative proctocolectomy : serious complication without long-term sequelae. Dis Colon Rectum 2007 ; 50 : 1540-1544 – reference: 17) Takagi S : Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy. Surg Endosc 1998 ; 12 : 427-431 – reference: 1) Poultsides GA, Lewis WC, Feld R, et al : Portal vein thrombosis after laparoscopic colectomy : thrombolytic therapy via the superior mesenteric vein. Am Surg 2005 ; 71 : 856-860 – reference: 3) Millikan KW, Szczerba SM, Dominguez JM, et al : Superior mesenteric and portal vein thrombosis following laparoscopic-assisted right hemicolectomy. Report of a case. Dis Colon Rectum 1996 ; 39 : 1171-1175 – reference: 7) Mijnhout GS, Klinkenberg EC, Lycklama G, et al : Sepsis and elevated liver enzymes in a patient with inflammatory bowel disease : think of portal vein thrombosis. Dig Liver Dis 2004 ; 36 : 296-300 – reference: 8) Fichera A, Cicchiello LA, Mendelson DS, et al : Superior mesenteric vein thrombosis after colectomy for inflammatory bowel disease : a not uncommon cause of postoperative acute abdominal pain. Dis Colon Rectum 2003 ; 46 : 643-648 – reference: 5) Okada T, Sasaki F, Minagawa N, et al : Postoperative portal and splenic vein thrombosis in children : identification of risk factors. Pediatr Surg Int 2005 ; 21 : 918-921 – reference: 10) Swartz DE, Felix EL : Acute mesenteric venous thrombosis following laparoscopic RouX-en-Y gastric bypass.JSLS 2004 ; 8 : 165-169 – reference: 11) Bradbury MS, Kavanagh PV, Bechtold BE, et al : Mesenteric venous thrombosis : diagnosis and noninvasive imaging. Radiographics 2002 ; 22 : 527-541 – reference: 13) Rosendaal FR : Venous thrombosis : a multicausal disease. Lancet 1999 ; 353 : 1167-1173 – reference: 12) Denninger MH, Chait Y, Casadevail N, et al : Cause of portal or hepatic venous thrombosis in adults : the role of multiple concurrent factors. Hepatology 2000 ; 31 : 587-591 – reference: 15) Jakimowicz J, Stultiens G, Smulders F : Laparoscopic insufflations of the abdomen reduces portal venous flow. Surg Endosc 1998 ; 12 : 427-431 – reference: 20) Schmandra TC, Kim ZG, Gutt CN : Effect of insufflations gas and intraabdominal pressure on portal venous flow during pneumoperitoneum in the rat. Surg Endosc 2001 ; 15 : 405-408 – reference: 21) Epstein RM, Wheeler HO, Frumin MJ, et al : The effect of hypercapnia on estimated hepatic blood flow, circulating splanchnic blood volume, and hepatic sulfobromophthalein clearance during beneral anesthesia in man. J Clin Invest 1961 ; 40 : 592-598 – reference: 16) Odeberg S, Ljungqvist O, Sollevi A : Pneumoperitoneum for laparoscopic cholecystectomy is not associated with compromised splanchnic circulation. Eur J Surg 1998 ; 164 : 843-848 |
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| Title | 腹腔鏡下結腸切除後に発症した上・下腸間膜静脈・門脈血栓症の1例 |
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