유문부 보존 췌십이지장 절제술 환자에서 발견이 어려웠던 가성동맥류를 내시경적 금속클립 유도하에 색전술을 시행한 1예
A Case of Successful Embolization with Superselection by Endoscopic Hemoclipping for Pseudoaneurysmal Bleeding in a Patient with Pylorus Preserving Pancreaticoduodenectomy
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초록
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 가성동맥류 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.
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.
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