感染性心内膜炎に対する僧帽弁置換術後早期に発症した特発性腹腔内出血の1例

Abdominal Apoplexy after Mitral Valve Replacement Due to Infective Endocarditis；Report of a Case

はじめに　Abdominal apoplexy（特発性腹腔内出血）は非常にまれな病態で，出血源が同定できない場合は致死的となりやすい．われわれは，感染性心内膜炎（IE）周術期に特発性腹腔内出血をきたし，内科的加療により良好な結果を得たので報告する．

A 52-year-old woman with mitral valve insufficiency and congestive heart failure due to infective endocarditis was treated by mitral valve replacement with a mechanical valve. Warfarin was started on postoperative day （POD） 3, but sudden onset of anemia with left abdominal pain presented on POD 8. Abdominal apoplexy was diagnosed by computed tomography （CT） and ultrasonographic imaging, but active bleeding was not evident. She was hemodynamically stable and her prothrombin time-international normalized ratio（PT-INR） at that time was 1.70 （compared with 2.56 on POD 7）. To avoid repeated bleeding, PT-INR was controlled at around 1.5. Other complications did not arise, and thereafter her postoperative course was favorable.