副腎褐色細胞腫からの後腹膜大量出血に対し,塞栓術による止血が有効であった1例

Abstract

68歳女.後腹膜腔への大量出血を引き起こした褐色細胞腫の例を経験した.塞栓術にて止血が可能で, 全身状態の充分な回復後に手術切除し得た.血管造影及び塞栓術は, 副腎出血の有効な診断及び治療法となりうると考えた

A 68-year-old woman was found crouching in the kitchen with severe upper abdominal pain. She entered a state of shock at our emergency clinic. Abdominal computed tomography (CT) scan demonstrated a 3 cm cystic mass dorsal to the pancreas tail accompanied with a hematoma. On angiography, a bleeding from the left middle adrenal artery was identified and embolized for hemostasis. An operation was performed 3.5 months after embolization. Preoperative evaluation showed the tumor to be endocrinologically inactive. Metoclopramide stimulation test was negative, too. Left adrenalectomy was performed uneventfully without intraoperative increase in blood pressure. However, histopathological diagnosis was pheochromocytoma. Transarterial embolization is an effective treatment for adrenal bleeding. In our case, however, embolization might have caused the tumor to be falsely "endocrinologically inactive".