Métairie S, Denimal F, Floch I, Pillet J C, Pittaluga P, Patra P, Chaillou P
Service de Chirurgie Vasculaire, Hôpital G et R Laennec, Boulevard Jacques Monod, St Herblain, 44093 Nantes, France.
Ann Vasc Surg. 2001 Nov;15(6):693-5. doi: 10.1007/s10016-001-0013-z.
This report describes a case of ruptured internal iliac artery aneurysm into the bladder after repair of an infrarenal abdominal aortic aneurysm. Aortic repair consisted of resection of the aneurysm followed by prosthetic interposition to reestablish arterial continuity. During the postoperative period, the patient had ischemia of left colon, which was successfully treated by the Hartmann procedure. A right internal iliac artery aneurysm measuring 50 mm in diameter was demonstrated by an abdominal CT scan during the initial hospitalization but was considered stable, since ultrasonography showed no change in diameter at 3 months and 1 year. The patient was lost from follow-up until 3 years later when he was hospitalized after rupture of the right iliac artery aneurysm, then measuring 120 mm in diameter, into the bladder. Surgical repair was undertaken. The procedure involved aortobifemoral bypass with suture of the bladder defect and branches of the internal iliac artery by the endoaneurysmal route. Postoperative recovery was uneventful. Upon reexamination 1 month after discharge from the hospital, the patient was asymptomatic. This rare case confirms the gravity of internal iliac artery aneurysm and the importance of therapeutic management to prevent rupture.
本报告描述了一例肾下腹主动脉瘤修复术后髂内动脉瘤破裂进入膀胱的病例。主动脉修复包括切除动脉瘤，然后植入假体以重建动脉连续性。术后期间，患者出现左半结肠缺血，通过哈特曼手术成功治疗。初次住院期间，腹部CT扫描显示一个直径50mm的右侧髂内动脉瘤，但由于超声检查显示3个月和1年时直径无变化，故认为其稳定。该患者失访3年，之后因右侧髂内动脉瘤破裂进入膀胱（此时直径为120mm）而住院，随后进行了手术修复。手术采用腹主动脉双股动脉旁路移植术，通过瘤内途径缝合膀胱缺损和髂内动脉分支。术后恢复顺利。出院1个月后复查，患者无症状。这一罕见病例证实了髂内动脉瘤的严重性以及预防破裂的治疗管理的重要性。
