Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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Emergency angioembolization performed in a hemodynamically unstable patient with grade V liver injury: The benefit of emergency angioembolization without computed tomography

혈역학적으로 불안정한 grade V 간손상에서 시행한 응급 혈관색전술: 전산화단층 촬영 없이 시행한 응급 혈관색전술의 이점

  • Kang, Wu Seong (Department of Trauma Surgery, Wonkwnag University Hospital) ;
  • Park, Chan Yong (Department of Trauma Surgery, Wonkwnag University Hospital)
  • 강우성 (원광대학교병원 외상외과) ;
  • 박찬용 (원광대학교병원 외상외과)
  • Received : 2018.11.28
  • Accepted : 2019.02.01
  • Published : 2019.02.28
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Abstract

High-grade liver injury is associated with high morbidity and mortality rates. We report successful emergency angioembolization and early interventional radiology support to manage a high-grade liver injury in a 29-year-old man who presented following a fall during parachute training. Upon arrival, his blood pressure was 80/40 mmHg, and emergency ultrasonography showed a liver injury with perihepatic fluid collection. The patient's blood pressure reduced to 60/40 mmHg, and emergency angiography was performed without computed tomography (CT) (door to puncture time 36 min). After angioembolization, his blood pressure returned to 120/77 mmHg. Subsequent CT revealed no additional bleeding or hollow viscus injury. He was admitted to the Intensive Care Unit and discharged without complications 30 days after admission. In this case, emergency angioembolization (without performing CT) could successfully and safely treat a hemodynamically unstable patient with a high-grade liver injury.

고도의 외상성 간손상은 높은 이환율과 사망율을 동반한다. 저자들은 혈역학적으로 불안정한 외상성 간손상 환자를 인터벤션 영상의학 전문의의 즉각적인 개입으로 빠른 혈관조영술을 시행함으로써 효과적으로 치료한 증례를 보고하고자 한다. 29세 남자가 낙하산 훈련 중 추락하여 본원 응급실을 통해 내원하였다. 초기 환자 혈압은 80/40 mmHg였고 응급 초음파 검사에서 간 열상과 주변에 혈액으로 보이는 체액이 관찰되었다. 내원 16분 후 수액 소생술을 시행에도 불구하고 혈압이 60/42 mmHg로 감소하여 전산화단층촬영을 생략하고 바로 혈관조영술을 시행하였다 (병원 도착 후 동맥 천자까지의 시간: 36분). 혈관조영술에서 우후간동맥 (right posterior hepatic artery) 출혈이 관찰되어 색전술을 시행하였다. 혈관색전술 후 환자의 혈압은 120/77 mmHg로 상승하였고, 생체징후가 안정된 후 전산화단층촬영을 시행하여 추가적인 출혈이나 내강장기의 손상이 없음을 확인하였다. 환자는 중환자실로 입원하여 보존적 치료를 시행하였으며, 내원 후 30일째 특별한 합병증 없이 퇴원하였다. 본 증례에서 혈역학적으로 불안정한 고도의 간손상 환자에서 전산화단층촬영을 생략하고 매우 빠르게 혈관조영술 및 색전술을 시행하여 안전하고 효과적으로 치료할 수 있었다.

Keywords

SHGSCZ_2019_v20n2_235_f0001.png 이미지

Fig. 1. Ultrasonography on arrival. The red arrow indicates fluid collection which was suspicious of blood.

SHGSCZ_2019_v20n2_235_f0002.png 이미지

Fig. 2. Emergency angiography was done without computed tomography (CT) (A) Massive extravasation from the branch of the right hepatic artery was observed. (red arrow) (B) The coil embolization for the posterior branch of the right hepatic artery was performed. (red arrow)

SHGSCZ_2019_v20n2_235_f0003.png 이미지

Fig. 3. (A) In pre-enhanced CT, the contrast media of the previous angiography was shown (red arrow). (B) In enhanced CT, there was no finding of additional bleeding.

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