外傷性頚髄損傷に伴ったmassive retropharyngeal hematomaの1例

A Case of a Massive Retropharyngeal Hematoma Associated with Traumatic Cervical Cord Injury

Ⅰ．はじめに

　Retropharyngeal hematomaは気道と隣接した場所に発生する占拠性病変であり，稀に気道閉塞を来し致死的になることがある⁴⁾．特に外傷性頚髄損傷の際にはほぼ必発であり，とりわけ抗血栓療法中は重症化しやすいとされる⁵⁾．今回，外傷性頚髄損傷に伴ったmassive retropharyngeal hematomaにより気道閉塞を来した1例を経験したので，文献的考察を含め報告する．

　Retropharyngeal hematomas are uncommon, but they may rarely cause occlusion of the upper airway and threaten life. Retropharyngeal hematomas often occur due to head or neck injury;they rarely occur due to iatrogenic causes such as insertion of a gastric tube or anticoagulant therapy. It has been found that patients receiving anticoagulant therapy are more likely to experience potentially severe retropharyngeal hematomas. We report the case of a patient with retropharyngeal hematoma with cervical cord damage. A 75-year-old man was transferred to our hospital after he sustained a fall and damaged his face. CT showed a massive retropharyngeal hematoma, but he did not complain of any breathing issues. Therefore, we selected conservative therapy. However, after approximately 4 hours, he suddenly complained of breathing problems and suffered from loss of consciousness. We performed intubation and provided sedation. After one week, his condition clearly improved and he was extubated.