| 特集名 | 維持透析患者の消化管疾患 ― 症状からみた傾向と対策 | |
|---|---|---|
| 題名 | 見逃してはならない急性腹症 ― 手術，特殊な血液浄化法 | |
| 発刊年月 | 2013年 02月 | |
| 著者 | 番匠谷 将孝 | あかね会土谷総合病院人工臓器部 |
| 著者 | 矢野 将嗣 | 広島鉄道病院外科 |
| 著者 | 川西 秀樹 | あかね会土谷総合病院人工臓器部 |
| 【 要旨 】 | 透析患者は健常人に比べて，憩室炎，消化管穿孔，虚血性腸炎，腸管梗塞などの消化管の急性腹症の発生頻度が高い．急性腹症のなかには予後不良な疾患も存在するため，早急な診断と治療が必要である．造影CT検査は簡便で初期診断に有用である．虚血性腸炎や腸管梗塞，消化管穿孔，絞扼性イレウスでは，時機を逸することなく，外科手術や血管内治療（interventional radiology；IVR）を行わなければならない．循環動態が不安定な場合は，持続的血液浄化法（CRRT）を行う．敗血症性ショックの合併例では，エンドトキシン吸着療法も選択される． | |
| Theme | Diseases of alimentary tract in maintenance dialysis patients -- tendency and management from a view point of symptomatology | |
|---|---|---|
| Title | Acute abdominal symptoms should not be missed in dialysis patients | |
| Author | Masataka Banshodani | Department of Artificial Organs, Tsuchiya General Hospital |
| Author | Masatsugu Yano | Department of Surgery, Hiroshima General Hospital of West Japan Railway Company |
| Author | Hideki Kawanishi | Department of Artificial Organs, Tsuchiya General Hospital |
| [ Summary ] | In comparison to healthy individuals, dialysis patients manifest a higher incidence of acute abdominal symptoms, which may be caused by various conditions such as diverticulitis, perforation of the lower gastrointestinal tract, ischemic colitis, or bowel infarction. Since patients with acute abdomen may have worse prognoses, they require prompt diagnosis and treatment. Contrast-enhanced computed tomography (CT) is a convenient, useful method for the initial diagnosis of acute abdomen. In patients with bowel infarction, ischemic colitis, gastrointestinal perforation, or strangulated intestinal obstructions, emergency surgeries or interventional radiology (IVR) should be performed as soon as possible. In patients with hemodynamic instability or septic shock, continuous renal replacement therapy (CRRT) or endotoxin absorbance therapy should be performed. | |