術中血管造影用カテーテルを用いた色素注入により至適切除範囲を決定し得た小腸angiodysplasiaの1例

Abstract

We report a case of angiodysplasia of the small intestine in a 72-year-old woman frequently admitted to the Department of Gastroenterology in our hospital complaining of gastrointestinal bleeding of unknown origin since September 2000. She had massive gastrointestinal bleeding on April 22, 2002. Angiography revealed extravasation from a peripheral region of the fourth branch of the jejunal artery with early venous pattern which was diagnosed as angiodysplasia. The angiographic catheter was kept inserted for intraoperatively. She entered shock status and underwent emergency surgery. During the operation, we could not find the fourth point accurately by inspection and palpation, and so injected indocyaningreen via the angiographic catheter to identify the optimal surgical range. The stained part of the jejunum was resected inthelengthof50crn. The resected specimen revealed the pin-hole like bleeding point. Pathological examination showed characteristic features of a submucosal angiodysplasia in the 20cm 1ength of the jejunum. We conclude that intraoperative dye injection with the angiographic catheter is the reasonable method to identify the optimal surgical range in patients with small bowel hemorrhage.