Details

Autor(en) / Beteiligte

• Nagata, Hiromitsu
• Yokoo, Naoki
• Kitakado, Yasuhito
• Shiroko, Takashi
• Ura, Katsuaki
• Tanaka, Yoshihiro
• Hamasu, Shinya

Titel

Retroperitoneal Hemorrhage Caused by Ruptured Branch of Superior Mesenteric Artery

Ist Teil von

• Nihon Kyukyu Igakukai Zasshi, 2003/01/15, Vol.14(1), pp.11-15

Ort / Verlag

Japanese Association for Acute Medicine

Erscheinungsjahr

2003

Beschreibungen/Notizen

• A 56-year-old woman hospitalized for severe upper abdominal pain and nausea 1 hour after eating dinner was found in abdominal ultrasonography (US) to have abnormal fluid collection. Enhanced abdominal computed tomography (CT) showed an irregular stain around the pancreatic head, suggesting retroperitoneal bleeding in that area. Emergency angiography suggested an aneurysma of the variational artery on the pancreaticoduodenal arcade, but we could not find the obvious bleeding point because of no extravasation was obvious. Emergency surgery was conducted with a diagnosis of retroperitoneal hemorrhage because the patient developed circulatory shock. During surgery, only venous bleeding was identified on the anterior side of the pancreatic head and on the retroperitoneum. A second emergency laparotomy was conducted 14 hours later after the first laparotomy because the patient suddenly developed hemorrhagic shock. During the second laparotomy, arterial bleeding on the posterior side of the pancreatic head and in the hepatoduodenal ligament was observed. The intraperitoneal hematoma was evacuated and the bleeding point ligated. This bleeding point differed from the previous one. No aneurysm was found in resected material, but imaging and operative findings showed the rupture of a variational blood vessel.