大動脈瘤術後虚血性腸炎の補助診断に血清乳酸値モニタリングが有用であった１例

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  • Validity of serum lactate monitoring in diagnosis of ischemic enterocolitis after thoracoabdominal aortic aneurysm repair: report of a case
  • report of a case

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It is well known that serum lactate is an endproduct of anaerobic metabolism in tissues or organs and that it increases in a condition of inappropriate oxygen supply. Moreover, it has been demonstrated that serum lactate level increases when acute mesenteric ischemia occurs. A case of acute mesenteric ischemia that was diagnosed by monitoring of serum lactate level in a patient who had undergone thoraco-abdominal aortic aneurysm repair is described. A 73-year-old female underwent repair of a throraco-abdominal aortic aneurysm. An aorto-superior mesenteric artery and aorto-celiac trunk bypass using an artificial graft and subsequent endoluminal stent-graft repair were carried out. Hemodynamic derangement and hypoxemia did not occur during or after the operation. However, serum lactate level gradually increased from 24mg·dl-1 to 75mg·dl-1, and metabolic acidosis developed from -5mEq·l-1 of base excess to -15mEq·l-1 over a period of 4 hours after operation, though the patient did not complain of clinical symptoms associated with ischemic enterocolitis. Since acute mesenteric artery ischemia was suspected because of remarkable elevation of serum lactate without shock or hypoxemia, an emergency operation was performed. It was found that the bypass graft from the aorta to the superior mesenteric artery was obstructed by kinking. An additional bypass was performed to prevent recurrence of acute mesenteric artery ischemia. After the second operation, the elevated serum lactate level decreased from 42mg·dl-1 to 18mg·dl-1 over a period of 4 hours. Monitoring of serum lactate level is thought to be a useful adjunct for the diagnosis of acute mesenteric ischemia after thoraco-abdominal aortic repair.

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