Details

Autor(en) / Beteiligte

• (Yu Suizu), 水津 悠
• (Kunio Hamanaka), 濱中 訓生
• (Satoru Beppu), 別府 賢
• (Nozomu Sasahashi), 笹橋 望
• (Masafumi Hashiguchi), 橋口 正史
• (Satoru Iwamoto), 岩本 諭
• (Kei Nishiyama), 西山 慶

Titel

正中弓状靱帯症候群による後上膵十二指腸動脈瘤破裂によりショックを呈し，後腹膜血腫による十二指腸閉塞症状を来した1例(A case of shock and duodenal obstruction due to the ruptured posterior superior pancreaticoduodenal aneurysm caused by median arcuate ligament syndrome)

Ist Teil von

• Nihon Kyūkyū Igakkai zasshi, 2018-01, Vol.29 (1), p.30-35

Erscheinungsjahr

2018

Quelle

Wiley Online Library - AutoHoldings Journals

Beschreibungen/Notizen

• 要旨 64歳の女性。めまい，悪心，腹痛を訴え救急車で来院した。来院時造影CT所見にて後腹膜に巨大な血腫を認め，後上膵十二指腸動脈瘤破裂による活動性の出血が疑われた。緊急腹部血管造影をし，同部位に対しコイル塞栓術を行い止血に成功した。術翌日から経口摂取を開始したが嘔気，嘔吐症状が継続し食事量の増量に難渋した。術後のCTや上部消化管内視鏡の所見で十二指腸が圧排され狭小化しており，後腹膜血腫による十二指腸閉塞症状との診断に至った。ある程度，食事量が確保できた時点で転院となり，転院先の病院の腹部エコーと当院のCTの所見で正中弓状靱帯症候群と診断された。その後，正中弓状靱帯症候群に対し侵襲的治療を行わず経過観察を行っている症例を経験したので報告する。 ABSTRACT A 64–year–old woman presented to the emergency department at our hospital with dizziness, nausea, and abdominal pain. Contrast–enhanced computed tomography (CT) showed a massive hematoma at the retroperitoneal space, and we suspected that there was active bleeding from a ruptured posterior superior pancreaticoduodenal aneurysm. Emergency angiography and transcatheter arterial embolization (TAE) confirmed the presence of a posterior superior pancreaticoduodenal aneurysm; therefore, embolization was performed. On the day following the operation, we permitted food intake; however, nausea and vomiting increasingly interrupted her meal. CT and upper gastrointestinal endoscopy performed after the operation showed narrowing of the duodenum because of the hematoma and revealed that the hematoma was caused by a duodenal obstruction. After the patient could eat a moderate amount of food, she was transferred to another hospital. We diagnosed the patient with median arcuate ligament syndrome based on CT findings from our hospital and findings from abdominal echography in the hospital to which she was transferred. We follow–up that median arcuate ligament syndrome after duodenal obstruction with a hematoma due to the ruptured aneurysm without invasive procedure.