全身麻酔下脳血管内治療後の抗凝固療法中にPONVによりマロリー・ワイス症候群から出血性ショックに至った1症例

Mallory-Weiss Syndrome and Hemorrhagic Shock due to Postoperative Nausea and Vomiting during Anticoagulation Therapy after Endovascular Surgery under General Anesthesia：A Case Report

要旨

　67歳の女性。右内頸動脈瘤に対して，セボフルランを使用し全身麻酔下で脳血管内手術を施行した。術後，抗凝固療法が開始されたが，その後，複数回の嘔吐からマロリー・ワイス症候群を発症し，出血性ショックに至った。抗凝固療法中のマロリー・ワイス症候群は重篤な状態に至る可能性があり，術後悪心・嘔吐（PONV）の予防と対策を十分に行う必要がある。

　A 67-year-old woman was admitted to our hospital for a right internal carotid aneurysm, and received cerebrovascular surgery under general anesthesia using sevoflurane. After surgery, she was transferred to the general intensive care unit where anticoagulant therapy was initiated. However, the patient developed Mallory-Weiss syndrome that began as recurrent vomiting and progressed to hemorrhagic shock. The Mallory-Weiss syndrome may have been exacerbated to a serious condition by the anticoagulant therapy. This case underscores the need to thoroughly prevent and treat postoperative nausea and vomiting in patients who are undergoing anticoagulant therapy after surgery.