Ambepitiya Sumithra Gamini Hewa, Michiue Tomomi, Bessho Yasumori, Kamikodai Yasunobu, Ishikawa Takaki, Maeda Hitoshi
Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
Forensic Sci Med Pathol. 2010 Jun;6(2):121-6. doi: 10.1007/s12024-009-9137-1. Epub 2010 Jan 20.
Ruptured aortic aneurysms often present with sudden death, and have varied signs and symptoms depending on the site of rupture and hemorrhage. We report a case of an aortic aneurysm with an aorto-esophageal fistula, which showed slow gastrointestinal bleeding for days before death. A 79-year-old male was brought to a hospital emergency unit, with a history of melena for about 3 days, and recent hematemesis. He collapsed immediately after endoscopy and died. A forensic autopsy which was performed due to possible medical malpractice demonstrated a large saccular aneurysm of the descending thoracic aorta with a fistula into the esophagus. A significant finding was a lid or valve shaped thrombus covering the aortic orifice of the fistula, which may have partly contributed to slow bleeding, and which may have been dislodged by endoscopy. This case suggests that very careful management of aorto-esophageal fistula is needed in patients with clinical signs of possible thoracic aortic aneurysm with slow hemorrhage.
主动脉瘤破裂常导致猝死，其体征和症状因破裂及出血部位而异。我们报告一例伴有主动脉 - 食管瘘的主动脉瘤病例，该病例在死亡前数天出现缓慢的胃肠道出血。一名79岁男性被送至医院急诊科，有大约3天的黑便病史，近期出现呕血。他在内镜检查后立即晕倒并死亡。因可能存在医疗事故而进行的法医尸检显示，降主动脉有一个大的囊状动脉瘤，伴有一个通向食管的瘘管。一个重要发现是有一个瓣状或瓣膜状血栓覆盖在瘘管的主动脉开口处，这可能是导致缓慢出血的部分原因，并且可能在内镜检查时被移位。该病例表明，对于有可能存在胸主动脉瘤且出血缓慢的临床体征的患者，需要极其谨慎地处理主动脉 - 食管瘘。
