腎臟動靜脈畸形自發性出血：病例報告
方琬云、陳俊吉、王百孚
彰化基督教醫院泌尿科
Renal Arteriovenous Malformation with Spontaneous Hemorrhage: A case report
Wan-Yun Fang, Chun-Chi Chen, Pai-Fu Wang
Department of Urology, Chunghwa Christian Hospital
Purpose:
Despite of congenital or acquired causes, renal arteriovenous malformation is extremely rare with incidence less than 1 per 30,000 patients in large autopsy study. We shared our experience of a case about renal arteriovenous malformation with spontaneous hemorrhage.
Case Presentation:
A 63 years old male, with history of left renal aneurysm post transcatheter arterial embolization (TAE) at out hospital years ago, had suffered from massive hematuria and general weakness on February 18th, 2018. There was no history of trauma nor hypertension. He went to emergency department and turned to hypovolemic shock quickly. Unable of performing TAE, he was transferred to our hospital and we arranged surgical rescue. Left nephrectomy, descending colon segmental resection, enterolysis and splenectomy were performed. Intra-operative cardiopulmonary resuscitation and extracorporeal membrane oxygenation were also arranged. After intensive care and series of operations, the patient expired on post operation 24th day because of septic shock and multiple organ failure.
Conclusion:
Even with multiple experienced subspecialties doctors, early TAE or operation in hybrid room may also be necessary to save lives. In patients with renal arteriovenous malformation, active surveillance and providing treatment aggressively would be more properly.