A CASE OF RUPTURED RIGHT GASTROEPIPLOIC ANEURYSM SUCCESSFULLY TREATED BY SURGICAL INTERVENTION

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  • 緊急手術により救命し得た右胃大網動脈瘤破裂の1例

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Abstract

Visceral abdominal aneurysms are rare, especially gastroepiploic aneurysm which represents only 1-5% of them. We experienced a patient with such rare gastroepiploic aneurysm who was successfully saved by an emergency operation. A 64-year-old man was admitted to the hospital by an ambulance because of a sudden onset of epigastralgia. There was a 20-year history of receiving hemodialysis for chronic renal failure. On admission, he was pale and drowsy with low blood pressure (66/30mmHg) and tachycardia (150/min), suggesting a hemodynamic shock state. His hemoglobin level was as low as 6.0g/dl. He had a diffuse abdominal pain with severe tenderness at the left upper quadrant. An ultrasonography showed intraperitoneal fluid collection. After a diagnosis of intraabdominal hemorrhage was made, emergency laparotomy was performed. There was a large amount of fresh blood in the peritoneal cavity. He was found to have a ruptured aneusysm at the right gastroepiploic artery. An extirpation of the aneurysms was carried out. He had an uneventful postoperative course and was discharged from the hospital in good condtion on the 25th day after the surgery. Histopathology revealed dissecting aneurysm, however, any pathogenetical evidence could not be detected. An early diagnosis followed by appropriate sugical or radiological intervention seemed to be critical in successful management of intraabdominal hemorrhage.

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