突発性脾動脈瘤破裂の1例 A CASE OF RUPTURED IDIOPATHIC ANEURYSM OF THE SPLENIC ARTERY
典型的なdelayed rupture phenomenonを呈し, CTで確診を得て,手術的に救命した特発性脾動脈瘤破裂の1例を経験した.症例は47歳男性で上腹部痛に引き続くショック状態にて搬入された. CTにより脾動脈瘤の描出を得て,緊急開腹し,脾門部の脾動脈瘤とともに脾臓摘出を施行した.組織学的には中膜の断裂を認めるのみで,基礎疾患,外傷歴もなく特発性と診断した.脾動脈破裂は,大動脈,腎動脈を除く腹部血管領域で最も多い動脈瘤破裂であり,その致死率は39%に及ぶ.上腹部痛,ショックで発症し網嚢腔内にタンポナーデされ一時的に止血される事もある(delayed rupture phenomenon).血管造影で確診がつく事が多いが本症例のようにCTで描出される事もある.脾動脈末梢に発生する事が多く脾摘術が施行される事が多い.救命には適切な急性期の管理と時期を失さない診断と治療が必要である.
We experienced a patient with ruptured idiopathic aneurysm of the splenic artery presenting typical delayed rupture phenomenon who was definitely diagnosed by CT and successfully operated on.<br> A 47-year-old man was transferred to the hospital because of an upper abdominal pain followed by shock. CT visualized an aneurysm of the splenic artery and an emergency laparotomy was performed. Splenectomy including the aneurysm at the splenic hilus was carried out. Histologically only an interruption of the tunica media was noted, and there was no previous history of having any underlying disease or trauma. So the aneurysm was diagnosed as idiopathic.<br> The splenic artery is the most common site for rupture of the aneurysm among all arteries except the aorta and renal artery. The mortality rate comes to 39%. It presents with upper abdominal pain and shock, and temporary hemostasis can occur due to tamponade in the omental bursa (delayed rupture phenomenon). Most cases can be definitely diagnosed by angiography, but some aneurysms are visualized by CT like this case. The aneurysm of the splenic artery predominantly appears in the branches of the splenic artery and consequent splenectomy is often employed. For successfully saving the lives of such patients, appropriate management of the disease in an acute stage and timely diagnosis and treatment are important.
- 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society
日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 57(5), 1217-1219, 1996-05-25
Japan Surgical Association