内容紹介
Summary
Case 1, a man in his 70s, was admitted because of a bleeding gastric ulcer during DCF therapy for esophageal cancer(EC). Three days after endoscopic hemostasis, abdominal pain and vomiting occurred. CT revealed hepatic portal venous gas(HPVG). No intestinal necrosis was observed on contrast-enhanced CT. Therefore, we selected a conservative treatment and found improvement. Case 2, a man in his 70s, developed frequent diarrhea during DCF therapy for EC. Case 3, a man in his 80s, developed hematochezie during DCF therapy for EC. Both cases 2 and 3 were diagnosed as HPVG using abdominal ultrasonography. The symptoms were mild, so we selected a conservative treatment and found improvement. Case 4, a man in his 60s, noticed sudden severe abdominal pain during DGS therapy for EC. Plain CT detected HPVG and gas in the small intestinal wall. We suspected intestinal necrosis due to HPVG with peritoneal irritation and performed emergency small intestine resection. We encountered 4 patients who developed HPVG during chemotherapy. The presence of HPVG is a poor prognostic sign, suggestive of intestinal necrosis, but some patients show improvement with conservative treatments. We also discuss previous reviews and reports.
要旨
症例1は70代,男性。食道癌に対しDCF療法中に胃潰瘍性出血を認めたため,内視鏡的止血術を施行した。3日後に腹痛,嘔吐が出現し,腹部CT検査で門脈ガスを認めた。造影CT検査では腸管壊死は認めず,保存的加療による軽快を得た。症例2は70代,男性。食道癌に対しDCF療法中に頻回の下痢が出現した。症例3は80代,男性。食道癌に対しDCF療法中に嘔気と腹痛が出現した。症例2,3ともに腹部エコー検査で門脈ガス血症と診断し,症状軽度のため保存的加療を選択し軽快を得た。症例4は60代,男性。食道癌に対しDGS療法中に突然の強い腹痛が出現した。腹部単純CT検査にて門脈ガスおよび小腸の腸管気腫を認めた。腹膜刺激徴候を伴う門脈ガス血症であり,小腸壊死を疑い緊急小腸部分切除術を施行した。われわれは,食道癌化学療法中の門脈ガス血症の4例を経験した。門脈ガス血症は腸管壊死を示唆する予後不良な徴候とされてきたが,近年保存的加療による改善を得られた報告も散見する。文献的考察を加え報告する。
目次
Case 1, a man in his 70s, was admitted because of a bleeding gastric ulcer during DCF therapy for esophageal cancer(EC). Three days after endoscopic hemostasis, abdominal pain and vomiting occurred. CT revealed hepatic portal venous gas(HPVG). No intestinal necrosis was observed on contrast-enhanced CT. Therefore, we selected a conservative treatment and found improvement. Case 2, a man in his 70s, developed frequent diarrhea during DCF therapy for EC. Case 3, a man in his 80s, developed hematochezie during DCF therapy for EC. Both cases 2 and 3 were diagnosed as HPVG using abdominal ultrasonography. The symptoms were mild, so we selected a conservative treatment and found improvement. Case 4, a man in his 60s, noticed sudden severe abdominal pain during DGS therapy for EC. Plain CT detected HPVG and gas in the small intestinal wall. We suspected intestinal necrosis due to HPVG with peritoneal irritation and performed emergency small intestine resection. We encountered 4 patients who developed HPVG during chemotherapy. The presence of HPVG is a poor prognostic sign, suggestive of intestinal necrosis, but some patients show improvement with conservative treatments. We also discuss previous reviews and reports.
要旨
症例1は70代,男性。食道癌に対しDCF療法中に胃潰瘍性出血を認めたため,内視鏡的止血術を施行した。3日後に腹痛,嘔吐が出現し,腹部CT検査で門脈ガスを認めた。造影CT検査では腸管壊死は認めず,保存的加療による軽快を得た。症例2は70代,男性。食道癌に対しDCF療法中に頻回の下痢が出現した。症例3は80代,男性。食道癌に対しDCF療法中に嘔気と腹痛が出現した。症例2,3ともに腹部エコー検査で門脈ガス血症と診断し,症状軽度のため保存的加療を選択し軽快を得た。症例4は60代,男性。食道癌に対しDGS療法中に突然の強い腹痛が出現した。腹部単純CT検査にて門脈ガスおよび小腸の腸管気腫を認めた。腹膜刺激徴候を伴う門脈ガス血症であり,小腸壊死を疑い緊急小腸部分切除術を施行した。われわれは,食道癌化学療法中の門脈ガス血症の4例を経験した。門脈ガス血症は腸管壊死を示唆する予後不良な徴候とされてきたが,近年保存的加療による改善を得られた報告も散見する。文献的考察を加え報告する。