冠状動脈バイパス術後にみられた後天性多囊胞化萎縮腎自然破裂の1例

Spontaneous Renal Rupture of Acquired Cystic Kidney Disease after Coronary Artery Bypass Grafting：Report of a Case

はじめに　近年，透析患者の増加とその管理の向上によって，透析患者の開心術は増加している．その際，高度な動脈硬化や長期透析の影響からか，通常の開心術よりも術後の合併症で苦慮することが少なくない．一方，長期透析患者に後天性多囊胞化萎縮腎（acquired cystic kidney disease：ACKD）が発生することは知られており，いわゆる「透析腎」と称され，経過中に自然破裂や癌の発生母地となることが問題である．

We described a hemodialysis patient with spontaneous renal rupture of acquired cystic kidney disease （ACKD） after off-pump coronary artery bypass grafting （OPCAB）. A 53-year-old man was transfer to our hospital with a diagnosis of unstable angina pectoris. He became ventilated due to congestive heart failure 3 days and underwent OPCAB on schedule 6 days after hospitalization. He suddenly complainted of colicky frank pain 31 days after surgery. Computed tomography （CT） demonstrated bulky hematoma with swollen kidney. Treatment included blood transfusions, withdrawal of anticoagulation, administration of vitamin K, and bed rest. The patient’s symptom disappeared. A month later CT showed that the hematoma had been absorbed.