A CASE REPORT OF A BLEEDING DUODENAL GASTROINTESTINAL STROMAL TUMOR RESECTED DURING EMERGENCY LAPAROSCOPIC SURGERY

症例は66歳，女性．消化管出血の診断で近医より当院紹介受診となる．CT，内視鏡検査にて下十二指腸曲の壁外性粘膜下腫瘍からの管腔内出血と診断した．内視鏡下に止血を行うも出血を繰り返し，入院3日後に吐血，出血性ショックを呈したために手術にて出血源である腫瘍を切除することとした．手術は気腹下に腫瘍を含めた腹腔鏡下十二指腸部分切除術を施行した．気腹開始後，血圧は上昇し術中バイタルサインは安定し，鏡視下に手術が可能であった．術後経過良好で術後16日目に退院となる．病理組織診断はgastrointestinal stromal tumorであった．気腹による腹腔内圧上昇は血圧を上昇させることが知られている．しかし出血性ショックに陥った症例に対する気腹下鏡視下手術は，術中の循環動態に大きく影響することから，その有用性については今後さらに検討が必要と考えられた．

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