市販のダイバーの肝臓に発生した枝状ガス：1 症例報告

Branch-like gas in a commercial diver's liver: a case report.

• Tao Yu
• Lina Liu
• Fei Xu
• Di Wu
• Yushun Su
• Qing Sun

抄録

海面下25～30m（msw）まで3時間のダイビングを繰り返した後、動悸、関節痛、頻脈、嘔吐を呈した42歳の商業用ダイバーの症例を報告する。潜水歴、数分以内の急激な浮上、軽度の低血糖性ショックを伴う全身症状から、重度の減圧症（Type II DCS）と診断されました。胴体に顕著な乳房切片を認めたほか、腹部CTで肝臓、腸間膜、腸にびまん性枝状肺炎を認めた。バイタルは比較的安定しており，腹部は軟らかく膨満しており，右上腹部は軽度の圧痛があった．本態性結晶質蘇生法に加えて高気圧酸素（HBO2）療法が行われた．腹部肺炎は2回のHBO2投与で完全に消失した。潜水後の腹腔内肺炎はDCSのまれな合併症である。我々の症例では，DCSの可能性がある症例に対して緊急の腹部CTがルーチン化されていないため，ダイビングドクターが迅速に診断することは困難であった．これらの症例、特に消化器症状を呈している場合には、通常は撮像剤の静脈内注射を伴う造影腹部CTを緊急に検討すべきであることを提案する。

We report the case of a 42-year-old commercial diver who presented with palpitations, arthralgia, tachypnea and vomiting after three hours of repetitive dives to 25-30 meters below sea level (msw). He was diagnosed with severe decompression sickness (Type II DCS) based on his dive history, his abrupt ascent to the surface within minutes, and systemic symptoms with mild hypovolemic shock. Besides remarkable cutis marmorata on the torso, the patient was also found positive for diffuse branch-like pneumatosis in the liver, mesentery and intestines on an abdominal computed tomography (CT). His vitals were relatively stable, with a soft distended abdomen and mild tenderness over the right upper quadrant. He was treated with hyperbaric oxygen (HBO2) treatment in addition to essential crystalloid resuscitation. The abdominal pneumatosis resolved completely after two HBO2 sessions. Post-diving intra-abdominal pneumatosis is a rare complication of DCS. In our case it was difficult for dive doctors to diagnose promptly because an emergency abdominal CT was not a routine for potential DCS cases. We propose that a contrast-enhanced abdominal CT, which usually involves a intravenous injection of imaging agent, should be considered in emergency management of these patients, especially when they present with gastrointestinal symptoms.

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