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We herein report successful endoscopic hemostasis in a patient with a bleeding from acquired ileal diverticulum. A 65-year-old woman was introduced to our hospital after the sudden onset of painless h...ematochezia. When emergency colonoscopy was performed, the site of bleeding could not be identified because of extensive blood pooling in the colon and ileocecal region. After admission, repeat colonoscopy with a transparent hood device after bowel preparation disclosed oozing of blood from an ileal diverticulum approximately 15 cm proximal to the ileocecal junction. We performed endoscopic therapy with injection of a hypertonic saline-epinephrine solution and placement of additional hemoclips in the diverticulum. Since the latter treatment, the patient had no recurrent hematochezia, and occult blood tests in stool had been negative. In cases of lower gastrointestinal bleeding, bleeding from an acquired ileal diverticulum should be considered and the terminal ileum carefully observed.
65 歳の女性が，下血を主訴に当院に紹介された．同日，緊急下部消化管内視鏡検査を施行したが，全大腸及び回盲部に著明な凝血塊を認め，明らかな出血源は同定できなかった．当院入院後，腸管洗浄液による前処置を行い，再度下部消化管内視鏡検査を施行したところ，回腸末端から口側約15cm に凝血魂の付着を伴う憩室を認めた．吸引により漏出性の出血を認め，出血源と判断し，HSE（hypertonic saline-epinephrine）局注法及びクリップによる内視鏡的止血術を施行した．施行後明らかな出血は認めなかった．下部消化管出血が疑われる場合，回腸憩室からの出血を念頭に置き，回腸末端を丹念に観察するべきであると考えられる．続きを見る
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Mendeley出力
fam99-2_p42