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증례 : 소화기 ; 알코올 간경변 환자에서 발생한 자발성 동맥 출혈의 3예
조윤주 ( Yun Ju Jo ),이지현 ( Ji Hyun Lee ),조영관 ( Young Kwan Jo ),안상봉 ( Byung Kwan Son ),손병관 ( Young Kwon Cho ),조영권 ( Young Kwon Cho ) 대한내과학회 2014 대한내과학회지 Vol.87 No.4
Spontaneous arterial bleeding has been reported rarely. In a patient consuming heavy amounts of alcohol with alcoholic liver cirrhosis, spontaneous bleeding can be evoked by thrombocytopenia, altered platelet function, and shear stress on fully dilated arteries by portal hypertension. Alcohol consumption itself can also predispose a patient to bleeding by influencing the aggregation and activation of platelets, and altering the coagulation and fibrinolysis pathway. All of these mechanisms could cause patients with alcoholic liver cirrhosis to bleed spontaneously; however, conditions inducing peripheral arterial bleeding are very rare. Here, we report three cases of spontaneous arterial bleeding in patients with liver cirrhosis consuming heavy amounts of alcohol. All of the patients bled without any physical trauma, and the involved arteries were the intercostal arteries in two cases and a gastroduodenal artery in the other case. The patients were treated by angiographic embolization. One expired due to recurrence of arterial bleeding despite repeated angiographic embolization and massive transfusion. (Korean J Med 2014;87:449-454)