Postoperative Disseminated Intravascular Coagulation in a Patient with Ureteral Metastasis from Gastric Cancer

胃癌輸尿管轉移患者術後產生瀰漫性血管內凝集

葉信志(Hsin-Chih Yeh) ； 蕭錫麟(Hsi-Lin Hsiao) ； 張圖豪(Tu-Hao Chang) ； 王勝嵐(Sheng-Lan Wang) ； 黃俊雄(Chun-Hsiung Huang) ； 吳文正(Wen-Jeng Wu)

《The Kaohsiung Journal of Medical Sciences》 24卷6期 (2008/06) Pp. 319-323

摘要

一位三年前曾因胃戒環細胞腺癌接受手術治療的66歲男性患者，在最近三個月因間歇性的左下腹悶痛而入院。影像學的檢查發現左側輸尿管阻塞併腎臟水腫，疑似為腫瘤包覆所引起。經內視鏡的輸尿管切片所取得的組織顯示為侵潤性的泌尿上皮癌，因此為病人施行左側腎輸尿管及膀胱袖口切除手術。但在比較前後兩次手術的組織切片後，最終的病理診斷為源自胃的左側輸尿管轉移癌。病人在術後產生急性彌慢性血管內凝集，雖然轉入加護病房密集照護，仍不幸於術後第十六天死亡。我們在此報告此罕見病例的細節並回顧相關的醫學文獻。

關鍵字

彌漫性血管內凝集 ； 胃戒環細胞腺癌 ； 輸尿管轉移

並列摘要

A66-year-old man, with a history of gastric signet ring cell carcinoma, was admitted due to intermittent dull pain in the left lower abdomen for 3 months. Left ureteral obstruction with suspicious tumor encasement and hydronephrosis was found on imaging studies. Endoscopic ureteral biopsy revealed infiltrating high-grade urothelial carcinoma. As a result, he underwent left nephroureterectomy and bladder cuff excision. Unexpectedly, metastatic carcinoma of the left ureter from the stomach was the final diagnosis after comparison of the permanent sections of the two specimens. Unfortunately, acute disseminated intravascular coagulation developed and the patient died of disease complications 16 days after the operation, even with intensive care. The details of this rare condition are reported herein with a review of the medical literature.

並列關鍵字

disseminated intravascular coagulation ； gastric signet ring cell carcinoma ； ureteral metastasis