Citation

Minagawa Y, Yoshida S, Takahashi M, Tohsya T, Shimooki O, Kaneko Y, Abe T. J. Jpn. Assoc. Surg. Trauma 2015; 29(1): 1-7.

Vernacular Title

小児自転車ハンドルにて受傷した鈍的肝損傷Ⅲbに対してダメージコントロール手術および経カテーテル動脈塞栓術を施行した1例

Copyright

(Copyright © 2015, Nihon gaisho gakkai Hen)

DOI

10.11382/jjast.29.1

PMID

unavailable

Abstract

The case was a 9-year-old boy. He fell while cycling and was transported to a nearby hospital. In this previous hospital, liver damage III b (Japan Trauma Society liver damage classification) was found by abdominal enhanced computed tomography (CT). His systolic blood pressure decreased to 60mmHg in the ambulance during transportation to our emergency and critical care center. Because of this hemodynamic instability, we decided on emergency open surgery and damage control surgery. We undertook TAE to stop the continuous bleeding that had lasted for 2 postoperative days. We closed the abdominal wall on the 6th postoperative day and discharged him on the 17th postoperative day. We thought that precise inspection and rapid decision are important when abdominal organ damage is predicted in children with upper abdominal pain due to bicycle handle trauma.

Language: ja

Vernacular Abstract

症例は9歳，男児.自転車運転中に転倒し，上腹部を強打し倒れているところを発見され前医を受診し，前医で腹部造影CT検査を施行しⅢb（日本外傷学会肝損傷分類）の診断であった.転院搬送中の救急車内で血圧60台まで低下，濃厚赤血球800ml輸血および昇圧剤を投与しながら当院救急センターに受傷から2時間32分後転院搬送となった.来院時血圧80/42mmHg，脈拍105/分，右季肋部に圧痛を認めfocused assessment with sonography for trauma（FAST）陽性であった.循環動態不安定なことから同日緊急手術（damage control surgery；DCS）を施行した.翌日持続性出血が遷延したためTAEを施行した.第6病日に閉腹し，第17病日に自宅退院となった.小児の自転車ハンドル外傷による上腹部痛では腹腔内臓器損傷を念頭に置いた迅速な判断と治療が必要である.