Adeeb S J, Yusha A W, Samad S A
Dept. of General Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia.
Med J Malaysia. 1997 Jun;52(2):178-80.
This is a case report of a pseudoaneurysm due to Salmonella aortitis in a 52 year old man. The condition is rare and represents one of the few cases reported in Malaysia. The diagnosis was made preoperatively by ultrasonography and computed tomography. This was confirmed at surgery where there was a 3 cm defect at the posterior wall of the aorta at L2/3 level. The aneurysmal sac extended to the retrocrural space at the 12th vertebra level cranially on the right side to the lower border of the 3rd lumbar vertebra caudally. It had a smooth fibrous wall and contained a mixture of organised haematoma and pus. At operation the aneurysm was excised, the affected region was carefully debrided and the aorta grafted with an in-situ in-lay graft. Antibiotic therapy was instituted until clinical response was evident, leukocytosis was reduced and blood culture was negative. However 4 months after surgery, the patient returned in irreversible shock and succumbed to disseminated intravascular coagulation secondary to massive upper gastrointestinal haemorrhage from an aortoduodenal fistula.
这是一例52岁男性因沙门氏菌性主动脉炎导致假性动脉瘤的病例报告。这种情况很罕见，是马来西亚报告的少数病例之一。术前通过超声检查和计算机断层扫描做出诊断。手术时证实，在L2/3水平的主动脉后壁有一个3厘米的缺损。动脉瘤囊向上延伸至第12胸椎水平的膈脚后间隙，右侧至第3腰椎下缘尾侧。它有一层光滑的纤维壁，内含有机化血肿和脓液的混合物。手术时切除了动脉瘤，仔细清创了受影响区域，并用原位镶嵌移植物对主动脉进行了移植。开始进行抗生素治疗，直到临床反应明显、白细胞增多症减轻且血培养呈阴性。然而，术后4个月，患者因主动脉十二指肠瘘导致大量上消化道出血继发弥漫性血管内凝血，出现不可逆休克并死亡。
