著者

髙須 香吏 中山 中 窪田 晃治

出版者

信州医学会

雑誌

信州医学雑誌 (ISSN:00373826)

巻号頁・発行日

vol.68, no.5, pp.249-257, 2020-10-10 (Released:2020-11-11)

参考文献数

34

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A 40-year-old woman who had undergone long-term hospitalization for schizophrenia was discharged. Four days later, she impulsively self-injured, was hospitalized with a prolapsed intestinal tract, and underwent emergency surgery. The wound on the left side penetrated the upper jejunum, mesenteric vessels, hilar region of the left kidney, iliopsoas, and a paravertebral nerve. The right involved the duodenum and vena cava. We repaired the each damage and performed left nephrectomy. The deadly triad was inferred, so we closed the wounds and transferred her to the ICU. Hemorrhagic shock continued for 31 hours, improved with massive blood transfusion. She then suffered from liver dysfunction, jaundice, renal insufficiency, hydrothorax and atelectasis, and abscess due to duodenal ruptured suture. Continuing care included dialysis, mechanical ventilation, thoracic and abdominal drainage, and nutritional management worked. The acute and subacute care ceased in week 12, and after rehabilitation, she was discharged by foot.We encountered an alive case suffered from definitive operation for multiple abdominal wound. We report it with inquest of the tactics and strategy.