Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

A Case of Successful Embolization with Superselection by Endoscopic Hemoclipping for Pseudoaneurysmal Bleeding in a Patient with Pylorus Preserving Pancreaticoduodenectomy

유문부 보존 췌십이지장 절제술 환자에서 발견이 어려웠던 가성동맥류를 내시경적 금속클립 유도하에 색전술을 시행한 1예

  • Kim, Yong-Hun (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Kwon, Chang-Il (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Joo, Sae-Kyung (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Kim, Won-Hee (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Bin, Hong-Gern (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Kim, Man-Deuk (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Hwang, Seong-Gyu (Digestive Disease Center, CHA Bundang Medical Center, CHA University)
  • 김용훈 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 권창일 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 주세경 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 김원희 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 빈홍건 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 김만득 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 황성규 (CHA 의과학대학교 분당차병원 소화기센터)
  • Received : 2009.10.14
  • Accepted : 2010.05.11
  • Published : 2010.07.30
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Abstract

Arterial bleeding after pancreaticoduodenectomy is a very serious complication with high mortality. Therefore, early diagnosis and treatment is essential. In particular, early detection and immediate embolization can be effectively used for the delayed massive bleeding that occurs from a pseudoaneurysmal rupture. However, sometimes intermittent bleeding or a vessel spasm can cause the bleeding focus to remain unidentified in spite of repeated angiography. We experienced a case of successful embolization with superselection by endoscopic hemoclipping in a patient who underwent pylorus preserving pancreaticoduodenectomy, and the patient's bleeding focus was not found after repeated angiography. Endoscopic hemoclip application can be useful for localizing a pseudoaneurysmal rupture in patients with pancreaticoduodenectomy.

췌십이지장 절제술 후에 발생하는 동맥 출혈은 수술 후 발생하는 주요한 합병증으로 출혈에 대한 조기 진단과 치료는 환자의 예후와 관련된 중요한 문제이다. 이러한 동맥 출혈 중 가성 동맥류 파열에 의한 지연성 출혈은 조기에 혈관 조영을 통하여 색전술을 시도하지만 간헐적 출혈이나 혈관 연축 때문에 드물게 출혈 병소가 확인되지 않을 수 있다. 저자들은 유문부 보존 췌십이지장 절제술 환자에서 반복적인 혈관조영술에서 발견이 어려웠던 가성동맥류를 내시경을 이용하여 출혈 병소 주위에 금속클립으로 표시를 한 후 성공적으로 병소를 발견하여 색전술을 시행한 예를 경험하여 문헌 고찰과 함께 보고한다.

Keywords

References

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