腹腔鏡下手術後の遅発性下腹壁動脈出血に対し血管内治療が奏効した1例

A case of successful endovascular treatment for hemorrhage of the inferior epigastric artery after laparoscopic surgery

◆要旨：症例は78歳，女性．急性胆囊炎に対し4ポートでの緊急腹腔鏡下胆囊摘出術を施行した．心房細動に対し，術前には抗凝固薬を内服していたが術後一時中止とし，後出血がないことを確認し，術後7日目に再開していた．術後13日目に突発する右下腹部痛で救急外来を受診した．貧血の進行と，CT検査で広範な右腹直筋血腫を認めた．画像所見では，血腫部位は腹腔鏡手術時の臍上第1トロッカー挿入部へ連続性を認めた．血管造影検査で右下腹壁動脈の分枝血管からの出血と診断し，緊急interventional radiology（IVR）治療を行い，止血を得た．今回われわれは，腹腔鏡下手術後に，遅発性下腹壁動脈出血をきたし，IVR治療を行った症例を経験したため，若干の文献的考察を加えて報告する．

　A 78-year-old female underwent emergency laparoscopic cholecystectomy. She has been taking oral anticoagulants for atrial fibrillation before the surgery, but they were temporarily discontinued after the surgery. After being confirmed that there was no postoperative bleeding, the drugs were resumed on postoperative day（POD）7. She returned to the emergency outpatient department with acute right lower abdominal pain on POD13. An abdominal hematoma was detected by computed tomography（CT） scan and the blood test showed anemia. Imaging findings showed that the location of hematoma was continuous with the insertion site of the first trocar above the umbilical cord from laparoscopic surgery. Hemostasis was obtained by embolizing the right epigastric artery by emergency interventional radiology（IVR）. In this study, we report a case of successful endovascular treatment for hemorrhage of the inferior epigastric artery that developed after laparoscopic surgery.