Key result
Kommerell's diverticulum enlargement after laparoscopic nephrectomy is linked to fatal respiratory failure from tracheal compression.
Case Report (n=1)
No
In dialysis patients with Kommerell's diverticulum, surgical procedures under general anesthesia carry a high risk of fatal postoperative airway obstruction due to diverticulum enlargement and fluid overload.
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May signal fatal airway risk after general anesthesia in Kommerell's diverticulum; leaves open optimal perioperative strategies for dialysis patients.
右側大動脈弓に左鎖骨下動脈が分枝し, その起始部が瘤化したKommerell憩室瘤は非常にまれな疾患である. 今回, 腎摘除術を契機にKommerell憩室瘤増大による気管狭窄をきたし死亡した腹膜透析患者の1例を経験したので報告する. 症例は78歳, 男性. 2009年糖尿病性腎症にて腹膜透析を導入した. 2005年に右側大動脈弓, 左鎖骨下動脈起始異常およびKommerell憩室瘤を指摘され, 当院心臓血管外科通院中であった. 経過観察中のCTで右腎癌を指摘され, 当科紹介受診した. 精査にて両側腎癌と診断され, 腹腔鏡下右腎摘除術を施行した. 術後, 抜管の際に喘息様発作を認め, ICUへ入室となった. 入室後抜管したが気管狭窄症状が強く再挿管となった. 気管支鏡で高度の気管狭窄を認め, Kommerell憩室瘤増大による気管狭窄と診断された. 浮腫軽減目的にCHDFでの除水を継続したが改善なく, 呼吸状態悪化により死亡した.
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Inoue et al. (2016) conducted a case report in Renal cell carcinoma, right-sided aortic arch, Kommerell's diverticulum (n=1). Laparoscopic nephrectomy was evaluated. A 68-year-old man with a right-sided aortic arch and Kommerell's diverticulum died of severe respiratory failure on postoperative day 16 due to tracheal compression from diverticulum enlargement after laparoscopic nephrectomy.
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