말기 신질환 환자에서 다발성 공장 게실 및 혈관 이형성증에 의한 대량출혈
Massive Bleeding from Jejunal Diverticulosis with an Angiodysplasia in a Patient with End Stage Renal Disease
이준현, 김욱, 김정수, 전해명,
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이준현 ( Lee Jun-Hyun )
가톨릭대학교 의과대학 외과학교실
김욱 ( Kim Wook )
가톨릭대학교 의과대학 외과학교실
김정수 ( Kim Jeong-Soo )
가톨릭대학교 의과대학 외과학교실
전해명 ( Jeon Hae-Myung )
가톨릭대학교 의과대학 외과학교실
KMID : 0371320020630060513
Abstract
Small bowel diverticulum, although not common and usually asymptomatic, can give rise to unexpected problems such as malabsorption, perforation, obstruction and bleeding. Bleeding from a diverticulum is often sudden and massive, therefore requiring
emergency operation. We report herein a case of a 75-year-old man who presented with massive bleeding from multiple jejunal diverticula. He had been diagnosed with hypertensive end stage renal disease and treated with hemodialysis since 14 years
previously. He was admitted with both hematemesis and hematochezia, and treated conservatively at first. However, bleeding continued and the anemia did not improve despite blood transfusions. An gastroduodenofiberscope and selected angiography revealed
no bleeding focus. An emergency laparotomy was performed and multiple jejunal diverticula, distributed from 15 to 60cm distal to the ligament of Treitz, were found. A segment of the jejunum containing all diverticula was resected and end to end
anastomosis was performed. A histologic examination revealed some dilated blood vessels in the submucosa of the diverticulum, which was compatible with the findings of the angiodyspiasia. Based on these findings, we suggest that angiodysplasia was the
cause of bleeding from the jejunal diverticula in this case.
키워드
공장 게실; 혈관 이형성증; 대량출혈; 말기 신질환; Jejunal diverticulosis; Angiodysplasia; Massive bleeding; End stage renal disease;
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