感染性上腸間膜動脈瘤破裂の1例  [in Japanese] A CASE OF INFECTED RUPTURED ANEURYSM OF TIE SUPERIOR MESENTERIC ARTERY  [in Japanese]

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Abstract

症例は46歳,男性.感染性心内膜炎の診断で僧帽弁置換術を施行された.術後27日目に突然の腹痛と吐下血が出現し,腹部造影CT検査で上腸間膜動脈瘤破裂と診断され,緊急手術が行われた.上腸間膜動脈を遮断した後に瘤を切開し,内側より縫合止血し得た.また,十二指腸空腸脚に動脈瘤の穿破を認め,同部の十二指腸を含め瘤を可及的に切除した.これより遠位側腸管の虚血はみられず,血行再建術は施行しなかった.病理学的には動脈硬化性変化はなく,感染性心内膜炎からの感染性塞栓に起因した動脈瘤と考えられた.術後に動脈瘤の再発,再出血がみられ, 2度の開腹止血術と1度の動脈塞栓術を必要とした.上腸間膜動脈瘤破裂例はオリエンテーションがつきにくく,縫合止血のみの手術となり再出血を引き起こす事が多い.本症例のごとく感染が関与している場合はさらに治療に難渋する場合が多く,早期の適切な外科的処置と術後の厳重な経過観察が重要であると考えられた.

A case of infected ruptured aneurysm of the superior mesenteric artery (SMA) is described. A 46-year-old man was referred to our hospital because of infective endocarditis (IE) involving the mitral valve. Because treatment with antibiotics was infective, and despite being in the active phase of infection associated with brain abscess, mitral valve replacement was performed successfully. One month later, the patient was found unconscious with massive hematemesis and melena. An abdominal CT scan showed a ruptured aneurysm of the SMA penetrating into the terminal duodenum. Direct suture of the SMA and combined resection of the aneurysm and the terminal duodenum seved the patient. However, recurrent bleeding from the involved artery obliged us to do additional repeat laparotomies and a transarterial embolization of the SMA. The clinical course and pathological findings which showed and inflammatory change of the aneurysm wall without atherosclerosis, suggested that the aneurysm was caused by vegetation derived from IE. Although ruptured aneurysm of the SMA associated with infection is rarely seen cafeful follow-up is necessary for the management of patients with IE.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 61(7), 1895-1899, 2000-07-25

    Japan Surgical Association

References:  11

Cited by:  3

Codes

  • NII Article ID (NAID)
    10008503010
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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