High risk PCIを実施後，重症後腹膜出血を来したが保存的治療に成功した1例

A Case of Conservative Therapy for Serious Retroperitoneal Hemorrhage after Performing High Risk PCI

要旨　患者は61歳，女性．維持透析中に狭心症が出現するようになり，当院へ紹介された．右鼠径部からのアプローチで冠動脈造影を行ったところ左前下行枝にtype Cの分岐部病変を認めた．同部に経皮的冠動脈形成術(PCI)を施行したが，同日夜間に穿刺部周辺に血腫が出現し血圧が低下した．翌日の腹部CTで後腹膜出血と診断され，出血源の検索のため腹部～大腿の動脈造影を実施したが，明らかな活動性出血は認められずショック状態が遷延し貧血が進行した．適宜輸血を実施しながらモニタリング下での血行動態管理を行った．術後4日間で合計濃厚赤血球10単位，血小板10単位の輸血を要したが，保存的治療により血行動態は安定し貧血も徐々に改善した．PCI後に出血源不明の重症後腹膜出血を来したが，外科的止血術を回避し厳重な血行動態管理下で保存的治療を行うことができた．

　A 61-year-old woman with a history of hoemodialysis for 7 years because of SLE nephritis was referred to our hospital became she had started to suffer from anginal attacks during hemodialysis. Coronary angiography was performed from the right femoral artery and showed a significant degree of stenosis(type C lesion)in the left anterior descending artery. The patient underwent percutaneouse coronary intervention(PCI)with two drug-eluting stents, and the lesion was dilated adequately. Five hours later, as her blood pressure decreased, a small subctaneous hematoma was recognized around the puncture site. Abdominal computed tomography revealed a massive retroperitoneal hematoma. Blood transfusion was given, but the patient remained anemic and in a state of shock. Abdominal arteriography was performed to detect the site of continuous bleeding, but no signs of active bleeding were found. The patient received blood transfusion repeatedly and was strictly monitored using a Swan-Ganz catheter. After a total of 10 units of red blood cell and 10 units of platelet transfusion for 4 days, her vital signs became stable and her anemia gradually improved. This is a case of conservative treatment of serious retroperitoneal hemorrhage with circulatory insufficiency. In such a case, surgical operation should be performed prudently even for a severely ill patient.