要旨　Mesenteric inflammatory veno–occlusive disease（MIVOD）は消化管および腸間膜に限局した原因不明の静脈炎により消化管虚血を来す稀な疾患で，一期的手術により予後は良好とされる。MIVODによる心停止で搬入され，蘇生後にdamage control strategyに基づく多期的手術と集中治療で救命し得たので報告する。81歳女性が12時間前からの腹痛，嘔吐で救急要請し，救急車内で心停止となった後，当院搬入となった。自己心拍は再開したが呼吸・循環状態は不安定であった。CTで腸管虚血を認め，緊急開腹術で壊死小腸を切除した。全身状態安定化と腸管壊死範囲拡大の可能性を考慮しdamage control strategyに基づき，damage control surgery（DC）およびopen abdominal management（OAM）を行った。壊死範囲の拡大に対してDC2とDC3で回盲部とS状結腸を切除しOAMを継続した。DC4で腸管虚血所見を認めず，人工肛門を造設し，根治的に閉腹した。経過良好で第64病日に神経学的後遺症なく退院した。全切除病理検体でMIVOD所見を認めた。MIVODが致死的となることを認識し，全身状態が不安定な症例はdamage control strategy のもと多期的手術が有効な可能性がある。

More from our Archive

• DOI: 10.1001/jama.2023.13239 2023

  Donanemab in Early Symptomatic Alzheimer Disease

  John R. Sims, Jennifer A. Zimmer, Cynthia D. Evans, Ming Lu, Paul Ardayfio, JonDavid Sparks, Alette M. Wessels, Sergey Shcherbinin, Hong Wang, Emel Serap Monkul Nery, Emily C. Collins, Paul Solomon, Stephen Salloway, Liana G. Apostolova, Oskar Hansson, Craig Ritchie, Dawn A. Brooks, Mark Mintun, Daniel M. Skovronsky, Rafael Abreu, Pinky Agarwal, Puja Aggarwal, Marc Agronin, Alison Allen, Dario Altamirano, Gustavo Alva, James Andersen, Allan Anderson, Donald Anderson, Jennifer Arnold, Takashi Asada, Yasuhiro Aso, Vikram Atit, Ricardo Ayala, Michael Badruddoja, Hanna Badzio-jagiello, Michal Bajacek, David Barton, David Bear, Sabrina Benjamin, Richard Bergeron, Perminder Bhatia, Sandra Black, Allan Block, Mohammad Bolouri, Wendy Bond, Jean Bouthillier, Sharon Brangman, Bruce Brew, Sarah Brisbin, Toby Brisken, Amy Brodtmann, Mark Brody, Jared Brosch, Celia Brown, Paul Brownstone, Sylwia Bukowczan, Jeffrey Burns, Alicia Cabrera, Horace Capote, Angel Carrasco, Jose Cevallos Yepez, Eric Chavez, Howard Chertkow, Urszula Chyrchel-paszkiewicz, Anthony Ciabarra, Edward Clemmons, Daniel Cohen, Robert Cohen, Ian Cohen, Mauricio Concha, Brian Costell, Denis Crimmins, Yvette Cruz-pagan, Adolfo Cueli, Robert Cupelo, Maciej Czarnecki, David Darby, P.l.j. Dautzenberg, Peter De Deyn, Jose De La Gandara, Kenneth Deck, David Dibenedetto, Mark Dibuono, Eric Dinnerstein, Ahmet Dirican, Shanker Dixit, Jacek Dobryniewski, Ryan Drake, Peter Drysdale, Ranjan Duara, John Duffy, Aaron Ellenbogen, Victor Faradji, Marc Feinberg, Robert Feldman, Simon Fishman, Stephen Flitman, Concetta Forchetti, Ivonne Fraga, Andrew Frank, Benjamin Frishberg, Hiroto Fujigasaki, Hiroyuki Fukase, Ileana Fumero, Kenichi Furihata, Christopher Galloway, Rekha Gandhi, Kristi George, Marcel Germain, Darren Gitelman, Nicholas Goetsch, Danielle Goldfarb, Mark Goldstein, Lawrence Goldstick, Yaneicy Gonzalez Rojas, Ira Goodman, David Greeley, Carl Griffin, Eric Grigsby, Daniel Grosz, Karl Hafner, David Hart, Sam Henein, Brad Herskowitz, Shinji Higashi, Yasuto Higashi, Gilbert Ho, Jonathan Hodgson, Mark Hohenberg, Larry Hollenbeck, Richard Holub, Tomokatsu Hori, Jakub Hort, Jan Ilkowski, K. Jennifer Ingram, Mitchell Isaac, Mitsunori Ishikawa, Lubos Janu, Mark Johnston, William Julio, William Justiz, Tomotsugu Kaga, Tatsuya Kakigi, Marvin Kalafer, Mikiko Kamijo, Jeffrey Kaplan, Michael Karathanos, Sadao Katayama, Siddharth Kaul, Andrew Keegan, Diana Kerwin, Uzma Khan, Arifulla Khan, Noriyuki Kimura, Gregory Kirk, Gabriela Klodowska, Hisatomo Kowa, Christen Kutz, Joseph Kwentus, Rosalyn Lai, Ayesha Lall, Mary Lawrence, Elly Lee, Ramon Leon, Gary Linker, Pawel Lisewski, Jonathan Liss, Collins Liu, Scott Losk, Ewelina Lukaszyk, Jennifer Lynch, Stephen Macfarlane, Josephine Macsweeney, Nicholas Mannering, Oto Markovic, Donald Marks, Joseph Masdeu, Yutaka Matsui, Kunitaka Matsuishi, Peter Mcallister, Brock Mcconnehey, Alvin Mcelveen, Lora Mcgill, Adam Mecca, Michael Mega, Jason Mensah, Anatol Mickielewicz, Artin Minaeian, Bharat Mocherla, Cynthia Murphy, Paul Murphy, Hirotaka Nagashima, Anil Nair, Malini Nair, John Nardandrea, Marshall Nash, Ziad Nasreddine, Yoshihiko Nishida, Jeffrey Norton, Lazaro Nunez, Jun Ochiai, Takuya Ohkubo, Yasuyuki Okamura, Eugene Okorie, Esteban Olivera, John O'mahony, Omid Omidvar, Desiree Ortiz-Cruz, Alexander Osowa, Michelle Papka, Alicia Parker, Paayal Patel, Ashok Patel, Meenakshi Patel, Claude Patry, Elizabeth Peckham, Michael Pfeffer, Alison Pietras, Michael Plopper, Anton Porsteinsson, Raphael Poulin Robitaille, Niels Prins, Orlando Puente, Marcin Ratajczak, Margaret Rhee, Angela Ritter, Ramon Rodriguez, Lilia Rodriguez Ables, Julio Rojas, Jeffrey Ross, Paule Royer, Jay Rubin, David Russell, Sterre Malou Rutgers, Stephanie Rutrick, Martin Sadowski, Beth Safirstein, Takafumi Sagisaka, Douglas Scharre, Lon Schneider, Curtis Schreiber, Michael Schrift, Paul Schulz, Harvey Schwartz, Julie Schwartzbard, John Scott, Lissette Selem, Pramod Sethi, Sharon Sha, Kenneth Sharlin, Sanjiv Sharma, Thomas Shiovitz, Rajinder Shiwach, Martin Sladek, Bart Sloan, Amanda Smith, Paul Solomon, Ehab Sorial, Evelio Sosa, Mary Stedman, Susan Steen, Lee Stein, Arkadiy Stolyar, John Stoukides, Shinji Sudoh, James Sutton, Junaid Syed, Kinga Szigeti, Hisatsugu Tachibana, Yuichi Takahashi, Amane Tateno, James Dale Taylor, Kelly Taylor, Oleg Tcheremissine, Adly Thebaud, Stephen Thein, Louise Thurman, Steven Toenjes, Hiromasa Toji, Misaki Toma, Duc Tran, Pilar Trueba, Masashi Tsujimoto, Raymond Turner, Akiyoshi Uchiyama, Dorota Ussorowska, Sanjeev Vaishnavi, Elena Valor, Joel Vandersluis, Alberto Vasquez, Juan Velez, Cherian Verghese, Klaudia Vodickova-borzova, David Watson, David Weidman, David Weisman, Alexander White, Katherine Willingham, Izabela Winkel, Paul Winner, Jaron Winston, Adam Wolff, Hideo Yagi, Hideki Yamamoto, Sanjay Yathiraj, Yasumasa Yoshiyama, Marzena Zboch,

• DOI: 10.1785/bssa0860030575 2023

  Three-dimensional simulation of earthquakes on the Los Angeles fault system

  Kim B. Olsen, Ralph J. Archuleta

• DOI: 10.1785/bssa0860030547 2023

  Source process of the 1995 Kobe earthquake: Determination of spatio-temporal slip distribution by Bayesian modeling

  Satoshi Ide, Minoru Takeo, Yasuhiro Yoshida

• DOI: 10.1785/bssa0860030761 2023

  Surface faulting of the 1954 Fairview Peak (<i>MS</i>7.2) and Dixie Valley (<i>MS</i>6.8) earthquakes, central Nevada

  S. J. Caskey, S. G. Wesnousky, P. Zhang, D. B. Slemmons

• DOI: 10.1785/bssa0860030683 2023

  Earthquake size as a function of fault slip rate

  John G. Anderson, Steven G. Wesnousky, Mark W. Stirling

• DOI: 10.1126/science.adf5872 2023

  Interface engineering for high-performance, triple-halide perovskite–silicon tandem solar cells

  Silvia Mariotti, Eike Köhnen, Florian Scheler, Kári Sveinbjörnsson, Lea Zimmermann, Manuel Piot, Fengjiu Yang, Bor Li, Jonathan Warby, Artem Musiienko, Dorothee Menzel, Felix Lang, Sebastian Keßler, Igal Levine, Daniele Mantione, Amran Al-Ashouri, Marlene S. Härtel, Ke Xu, Alexandros Cruz, Jona Kurpiers, Philipp Wagner, Hans Köbler, Jinzhao Li, Artiom Magomedov, David Mecerreyes, Eva Unger, Antonio Abate, Martin Stolterfoht, Bernd Stannowski, Rutger Schlatmann, Lars Korte, Steve Albrecht

• DOI: 10.1126/science.adg0091 2023

  Interface passivation for 31.25%-efficient perovskite/silicon tandem solar cells

  Xin Yu Chin, Deniz Turkay, Julian A. Steele, Saba Tabean, Santhana Eswara, Mounir Mensi, Peter Fiala, Christian M. Wolff, Adriana Paracchino, Kerem Artuk, Daniel Jacobs, Quentin Guesnay, Florent Sahli, Gaëlle Andreatta, Mathieu Boccard, Quentin Jeangros, Christophe Ballif

• DOI: 10.1126/science.adh2586 2023

  Experimental evidence on the productivity effects of generative artificial intelligence

  Shakked Noy, Whitney Zhang

• DOI: 10.1126/science.adg4084 2023

  An improved bound on the electron’s electric dipole moment

  Tanya S. Roussy, Luke Caldwell, Trevor Wright, William B. Cairncross, Yuval Shagam, Kia Boon Ng, Noah Schlossberger, Sun Yool Park, Anzhou Wang, Jun Ye, Eric A. Cornell

• DOI: 10.1001/jama.2023.10578 2023

  Diabetic Foot Ulcers

  David G. Armstrong, Tze-Woei Tan, Andrew J. M. Boulton, Sicco A. Bus