Kawahara K, Okada M, Hayashi T, Fujita Y, Sasaki M, Okada S, Kurata A
Department of Pathology, Osaka National Hospital, Osaka 540-0006.
Rinsho Byori. 2001 Jan;49(1):77-81.
We present an autopsy case of aortoduodenal fistula complicated by both gastric carcinoma and acute gastric mucosal lesions(AGML). A 73-year-old man with a past history of gastric ulcer, myocardial infarction, and arteriosclerosis of the right femoral artery presented to Osaka National Hospital complaining of intermittent claudication of the right lower extremity. After a diagnosis of arteriosclerosis obliterans, percutaneous angioplasty was performed. The postoperative course was initially good. However, two weeks after the angioplasty procedure he suddenly vomited blood. Emergency endoscopy revealed both polypoid gastric carcinoma and AGML, which were considered to be the major cause of his gastrointestinal bleeding. And he died of uncontrollable gastrointestinal bleeding two weeks after this examination. Autopsy showed an atherosclerotic aneurysm of the abdominal aorta that had ruptured into the third part of the duodenum. To our knowledge, there has been no previous autopsy on a primary aortoduodenal fistula from an atherosclerotic abdominal aneurysm complicated by similar hemorrhagic gastric lesions. This case emphasizes the difficulty of making a clinical diagnosis of primary aortoduodenal fistula.
我们报告一例主动脉十二指肠瘘尸检病例，该病例合并胃癌和急性胃黏膜病变（AGML）。一名73岁男性，有胃溃疡、心肌梗死和右股动脉动脉硬化病史，因右下肢间歇性跛行就诊于大阪国立医院。诊断为闭塞性动脉硬化后，进行了经皮血管成形术。术后病程起初良好。然而，血管成形术后两周，他突然吐血。急诊内镜检查发现息肉样胃癌和AGML，这被认为是他胃肠道出血的主要原因。此次检查两周后，他死于无法控制的胃肠道出血。尸检显示腹主动脉粥样硬化性动脉瘤破裂至十二指肠第三部。据我们所知，此前尚无关于由腹主动脉粥样硬化性动脉瘤并发类似出血性胃部病变引起的原发性主动脉十二指肠瘘的尸检报告。该病例强调了原发性主动脉十二指肠瘘临床诊断的困难。
