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A blood culture taken on day X was positive for E. coli, and the patient was admitted to the hospital for further examination and treatment. Contrast-enhanced computed tomography(CT)revealed an ileal mass, multiple hypoabsorptive areas in the spleen, and portal vein thrombosis. Antibiotic treatment was started because the ileocecal mass was thought to be the entry point for the bacteremia and splenic\nabscess. Anticoagulants were also started for portal vein thrombosis. The blood culture on X+16 was negative. However, a severe inflammatory response persisted, and the patient had recurrent\nhigh fevers. As the sIL-2R level was high, we suspected malignant lymphoma. Consequently we performed a surgical biopsy of the ileocecal mass. Although contrast-enhanced CT on X+23\nshowed that the portal vein thrombosis was improving, the hypo-absorptive zone of the spleen increased. The patient experienced left upper abdominal pain during the same period. 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保存的加療3週間後に脾膿瘍破裂を来した一例
https://redcross.repo.nii.ac.jp/records/2001550
https://redcross.repo.nii.ac.jp/records/2001550e0b92ab5-14d4-4a17-8e30-c75a628fd6d9
名前 / ファイル | ライセンス | アクション |
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matsuyama00129.pdf (950 KB)
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Item type | 学術雑誌論文 / Journal Article(1) | |||||||||||||||
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公開日 | 2024-02-13 | |||||||||||||||
タイトル | ||||||||||||||||
言語 | ja | |||||||||||||||
タイトル | 保存的加療3週間後に脾膿瘍破裂を来した一例 | |||||||||||||||
タイトル | ||||||||||||||||
言語 | en | |||||||||||||||
タイトル | A case of ruptured splenic abscess after3weeks of conservative treatment | |||||||||||||||
言語 | ||||||||||||||||
言語 | jpn | |||||||||||||||
キーワード | ||||||||||||||||
言語 | en | |||||||||||||||
主題 | splenic abscess | |||||||||||||||
キーワード | ||||||||||||||||
言語 | en | |||||||||||||||
主題 | rupture | |||||||||||||||
キーワード | ||||||||||||||||
言語 | en | |||||||||||||||
主題 | portal vein thrombosis | |||||||||||||||
キーワード | ||||||||||||||||
言語 | en | |||||||||||||||
主題 | pylephlebitis | |||||||||||||||
資源タイプ | ||||||||||||||||
資源タイプ識別子 | http://purl.org/coar/resource_type/c_6501 | |||||||||||||||
資源タイプ | journal article | |||||||||||||||
アクセス権 | ||||||||||||||||
アクセス権 | open access | |||||||||||||||
アクセス権URI | http://purl.org/coar/access_right/c_abf2 | |||||||||||||||
著者 |
大田,佳奈
× 大田,佳奈
× 岡, 英明
× 森實, 岳史
× 上田, 晃三
× 南, 一仁
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抄録 | ||||||||||||||||
内容記述タイプ | Abstract | |||||||||||||||
内容記述 | 症例は71歳男性で,右足首の痛み,繰り返す悪寒戦慄と発熱を主訴に X-1日当院救急外来を受診した.X 日になり血液培養から大腸菌が発育したため,精査加療目的で入院した.造影 CT で回盲部腫瘤と脾臓に多発する低吸収域,門脈血栓症を認め,回盲部腫瘤を侵入門戸とした菌血症と脾膿瘍と考え抗菌薬加療を開始した.また門脈血栓症に対しては 抗凝固薬を開始した.X+16日の血液培養は陰性だったが,炎症反応高値が持続し高熱を繰り返した.sIL‐2R 高値であったため悪性リンパ腫を疑い,回盲部腫瘤を外科的生検する方針とした.X+23日の 造影 CT で門脈血栓症は改善を認めたが脾臓低吸収域は増大しており,同時期より左上腹部痛を自覚した.X+25日の回盲部腫瘤生検目的での手術中に,脾膿瘍破裂に伴う汎発性腹膜炎と判明し,方針を変更して脾臓摘出術を施行した.発熱や炎症反応は改善し X+42日に退院した.本症例のように門脈血栓症が存在し,血液培養が陽性の場合には化膿性門 脈炎を念頭に置く必要があり,さらに脾臓に囊胞性病変を認めた際には脾膿瘍を疑う必要がある.脾膿瘍と診断し保存的加療を選択した場合には,早期に治療反応性を評価して外科的治療を追加するか検討する必要がある. |
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言語 | ja | |||||||||||||||
抄録 | ||||||||||||||||
内容記述タイプ | Abstract | |||||||||||||||
内容記述 | A 71-year-old man was admitted to the emergency department on X-1 with complaints of right ankle pain, recurrent chills, shivering, and fever. A blood culture taken on day X was positive for E. coli, and the patient was admitted to the hospital for further examination and treatment. Contrast-enhanced computed tomography(CT)revealed an ileal mass, multiple hypoabsorptive areas in the spleen, and portal vein thrombosis. Antibiotic treatment was started because the ileocecal mass was thought to be the entry point for the bacteremia and splenic abscess. Anticoagulants were also started for portal vein thrombosis. The blood culture on X+16 was negative. However, a severe inflammatory response persisted, and the patient had recurrent high fevers. As the sIL-2R level was high, we suspected malignant lymphoma. Consequently we performed a surgical biopsy of the ileocecal mass. Although contrast-enhanced CT on X+23 showed that the portal vein thrombosis was improving, the hypo-absorptive zone of the spleen increased. The patient experienced left upper abdominal pain during the same period. On X+25, at the time of ileal mass biopsy, generalized peritonitis following the rupture of a splenic abscess was detected. Hence, a splenectomy was performed. The patientʼs fever and inflammatory response improved and he was discharged on X+42. When portal vein thrombosis is present and blood culture is positive, as in our case, pylephlebitis should be considered. Moreover, a splenic abscess should be suspected when cystic lesions are found in the spleen. If a splenic abscess is diagnosed and conservative treatment is chosen, the patientʼs treatment response should be evaluated early to determine whether surgical treatment should be added. |
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言語 | en | |||||||||||||||
書誌情報 |
松山赤十字病院医学雑誌 The Matsuyama Red Cross Hospital Journal of Medicine 巻 48, 号 1, p. 59-64, 発行日 2023-12-28 |
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出版者 | ||||||||||||||||
出版者 | 松山赤十字病院 | |||||||||||||||
ISSN | ||||||||||||||||
収録物識別子タイプ | ISSN | |||||||||||||||
収録物識別子 | 0385-3888 | |||||||||||||||
書誌レコードID | ||||||||||||||||
収録物識別子タイプ | NCID | |||||||||||||||
収録物識別子 | AN00232808 | |||||||||||||||
著者版フラグ | ||||||||||||||||
出版タイプ | VoR | |||||||||||||||
出版タイプResource | http://purl.org/coar/version/c_970fb48d4fbd8a85 |