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◆要旨:患者は72歳,男性.既往に陳旧性心筋梗塞と完全内臓逆位症があり外来フォローされていたが,ふらつき・黒色便の出現とともに著明な貧血(Hb 6.1g/dl)を指摘された.上部消化管内視鏡検査にてびまん性胃前庭部毛細血管拡張症と診断され出血源と考えられた.APC焼灼術を繰り返し行ったが出血コントロール困難で,外科的切除の方針となった.術前3D-CT画像から血管亜型と温存すべき心臓へのバイパス血管の走行を把握し,腹腔鏡下幽門側胃切除術を施行した.冠動脈バイパス術の既往がある完全内臓逆位症を伴った症例に対してグラフト血管を温存した腹腔鏡下幽門側胃切除術を施行した報告例はなく,文献的考察を加えて報告する.
A 72-year-old man with complete situs inversus who underwent coronary artery bypass graft twelve years ago complained of dizziness and developed tarry stool and severe anemia during medical follow up. Upper gastrointestinal endoscopy revealed diffuse antral vascular ectasia(DAVE) and we considered it was the cause of the bleeding. Argon plasma coagulation was performed, but the patient was repeatedly transfused for intermittent tarry stools due to recurrence of the DAVE and we performed laparoscopic distal gastrectomy(LDG) preserving the gastroepiploic artery graft. Preoperative 3-dimensional(3D) CT showed in detail, the vascular anomaly and the location of gastroepiploic artery which bypassed to the right coronary artery. To our knowledge, it is the first case of recurrent DAVE with complete situs inversus treated with LDG preserving the GEA graft.
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