著者

大山 莉奈 塩谷 猛 小峯 修 南部 弘太郎 渡邉 善正 渋谷 肇

出版者

一般社団法人 日本消化器外科学会

雑誌

日本消化器外科学会雑誌 (ISSN:03869768)

巻号頁・発行日

vol.49, no.10, pp.971-978, 2016-10-01 (Released:2016-10-20)

参考文献数

16

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症例は75歳の女性で,筋委縮性側索硬化症にて他院に通院中であり嚥下機能低下に対し1年前に胃瘻造設術を施行されていた.急激な腹部膨満を認め腸閉塞の疑いで当科へ搬送され精査の結果胃軸捻転症の診断となった.同日緊急で開腹胃壁固定術を施行し,再度胃瘻の使用が可能となった.難治性神経疾患を持つ患者の場合は,胃瘻造設後これを軸として胃軸捻転症を発症する可能性があり,急性腹症の鑑別の一つとして考慮すべきであると考え報告する.

著者

松崎 粛統 須磨 健 渋谷 肇 中村 真 平山 晃康 片山 容一

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 = Surgery for cerebral stroke (ISSN:09145508)

巻号頁・発行日

vol.38, no.5, pp.353-357, 2010-09-30

参考文献数

18

被引用文献数

1 1

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A 57-year-old man was referred to our hospital for detailed investigation and therapy of right exophthalmos and chemosis. Cerebral angiography demonstrated a dural arteriovenous fistula (DAVF) involving an anterior part of the right cavernous sinus (CS). The main feeders of the CS-DAVF consisted of the right inferolateral trunk and right middle meningeal artery. The predominant drainage route was the right superior ophthalmic vein (SOV), extending to the right facial vein. The right inferior petrosal sinus (IPS) was not visualized in the arterial phase, but was visualized in the venous phase, indicating that it contributes normal venous drainage. Transvenous embolization (TVE) was performed under general anesthesia through the right facial vein. We advanced a guiding catheter in the right angular vein and passed a microcatheter system through the tortuous vessel to the shunting point under single plane road mapping. The affected anterior part of the CS was occluded with Micrus coils (UltiPaq and Cashmere) (Micrus Endovascular, San Jose, CA, USA). Post-treatment angiography revealed disappearance of the fistula. <br> In general, CS-DAVFs are treated with TVE through the IPS. However, in the present case, IPS was not used for the approach based on the angiographic appearance. Large drainage volume of the right facial vein enabled us to advance the guiding catheter to the angular vein with facility, and to pass the microcatheter system through the tortuous vessel with sufficient support of the guiding catheter. Cashmere, which is a 14 system infinity loop-shaped coil and relatively soft as a framing coil, had a tendency to attach to the anterior part of the CS wall. <br> Because of good packing efficiency, transvenous Micrus coil embolization through the facial vein is an efficient treatment of DAVF involving the anterior part of the CS.<br>