인하대병원 최윤아.

Presentation on theme: "인하대병원 최윤아."— Presentation transcript:

1 인하대병원 최윤아

2 C. C : melena (onset : 2days ago) Present illness :
Case presentation 집답회 Age/sex : M/51 C. C : melena (onset : 2days ago) Present illness : 06.11월 duodenal ca 진단 받고 휘플씨 수술과 06.12월 보존적 1차 항암치료 (5-FU+CDDP)를 투여 받았다. 07.2월에 내원 2일전부터 시작된 간헐적인 흑색변 및 어지러움증으로 내원하였다.

3 - general weakness (+), poor oral intake (+) - dyspnea(+)
Case presentation 집답회 R.O.S - general weakness (+), poor oral intake (+) - dyspnea(+) - dizziness(+),melena (+), hematochezia (-) - abdominal pain (-) Physical examination V/S :144/84mmHg-114회/분-20회/분-36℃ HEENT isocoric pupil size pupil light reflex (+/+) anemic conjunctiva anicteric sclera

4 Symmetric expansion without retraction CBS and RHB Abdomen Soft & flat
Case presentation 집답회 Physical examination Chest Symmetric expansion without retraction CBS and RHB Abdomen Soft & flat Normoactive bowel sound T/RT (-/-), hepatosplenomagaly(-) Back & Extremity Costovertebral tenderness (-/-) Pretibial pitting edema (-/-) Skin rash (-) rectal exam : positive L-Tube irrigation(-)

5 total protein 5.6g/dL, albumin 3.1 g/dL, T. bil : 0.3 mg/dL,
Case presentation 집답회 Lab finding - CBC : 5200/mm3-4.4g/dL /mm3 (Neu 53.0%, Lym 38%) - Admission PANEL total protein 5.6g/dL, albumin 3.1 g/dL, T. bil : 0.3 mg/dL, AST 19 IU/L, ALT 11 IU/L BUN/Cr 20/0.7 mg/dL - PT 76% (INR 1.20) a PTT sec

6 EGD, Colonoscopy, Bleeding scan, Angio mesenteric CT

7 Case presentation 집답회 경과 까지 입원 하면서 Packed RBC 6 Pint transfusion 시행 하면서 Bleeding 없어 경과 관찰 후 퇴원하였으나 다음날 다시 흑색변 으로 입원 - CBC : 8000/mm3-7.7 g/dL /mm3 (Neu 58.5%, Lym 34.4%) Rectal exam: Positive

8 Case presentation 집답회 Hyperemic elevated mucosal lesion (1.2Cm) with easy touch bleeding at hepaticojejunostomy stite

9 경과 #6 FP chemo 까지 치료 한뒤에 07.10 월 다시 melena, hematochezia 로 내원
Case presentation 집답회 경과 #6 FP chemo 까지 치료 한뒤에 월 다시 melena, hematochezia 로 내원

10 Case presentation 집답회 EGD & Colonoscopy 시행

11 Colonoscopy

12 Case presentation 집답회 재출혈 한달뒤 07.11월 choledochojejunostomy revision 시행 하였고 08. 4월 출혈 없는 상태로 경과 관찰하고 있음

13 Morbidity rate remains high and is currently between 30% and 40%
Review Mortality rate after pancreatoduodenectomy (PD) has decreased during the last decade to 0-5% Morbidity rate remains high and is currently between 30% and 40% The most common complications after PD are pancreatic leak and pancreatic fistula, gastric stasis, bile leak, intra-abdominal abscess and haemorrhage Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients Claudio Bassi, Massimo Falconi, Roberto Salvia, Giuseppe Mascetta, Enrico Molinari, Paolo Pederzoli Dig Surg 2001;18:

14 Review Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed I.Koukoutsis, R. Bellagamda, G.Morris-Stiff, S. Wickremesekera, C.Coldham, S.J.Wigmore, A.D.Mayer, D.F. Nirza Dig Surg 2006;23:

15 Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed
I.Koukoutsis, R. Bellagamda, G.Morris-Stiff, S. Wickremesekera, C.Coldham, S.J.Wigmore, A.D.Mayer, D.F. Nirza Dig Surg 2006;23:

16 Thank you for your attention