胃粘膜下血腫を動脈塞栓術で止血し内視鏡所見の変化を観察し得た1例

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  • A case of giant gastric submucosal hematoma treated with transcatheter embolization

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<p> A woman in her 60’s was admitted to our hospital due to sudden onset hematemesis. She underwent maintenance haemodialysis and took anticoagulant therapy for atrial fibrillation. Endoscopic examination revealed a large submucosal hematoma in the antrum of the stomach. We attempted to treat conservatively at first. But anemia progressed and the computer tomography on admission had showed extravasation, therefore angiography was done for hematoma. Extravasation was noted at the branch of gastroepiploic artery, and transcatheter arterial embolization (TAE) was performed to it. After TAE, anemia improved gradually. Endoscopic examination on the eleventh hospital day revealed a giant ulcer with remarkable mound. On the eighteenth hospital day, endoscopic examination showed an open ulcer with flat flour. Further, six months later, endoscopic examination showed smooth ulcer scar without deformation of the stomach. In the present case, anticoagulant therapy, maintenance hemodialysis and decreased platelets count may be background factors related to gastric submucosal hematoma. We presented this case because gastric submucosal hematoma treated with TAE is rare and we could endoscopically observe the healing process ; giant submucosal hematoma, giant open ulcer induced by disintegration of hematoma and smooth ulcer scar without deformity.</p>

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