Sima L, Tirziu R, Iliescu D, Blidisel A, Hut F, Streian C
Emergency General Surgery Department, Emergency Clinical City Hospital Timisoara, UMF "V. Babes" Timisoara, Romania.
Chirurgia (Bucur). 2010 Sep-Oct;105(5):717-20.
Gastroduodenal artery (GDA) aneurysm is a rare entity, comprising only 1.5% of all 3000 cases of visceral artery aneurysms that have been reported in literature. We report a case of a 55-year-old Caucasian man, diagnosed with right inguinal hernia. He was admitted to our department for surgical treatment. His medical history was remarkable for hypertension, and angina. He was operated the next day. A external oblique right inguinal hernia was diagnosed intraoperative. The Halsted technique was used for primary inguinal hernia. Immediate postoperative evolution was favorable, systolic blood pressure of 120 mmHg, pulse of 68 beats/minute. 16 h postoperative there was a sudden alteration of the general condition with signs of hemodynamic shock, with a systolic blood pressure of 60 mmHg, tachycardia of 110 beats/min. Physical examination revealed a pale, cold, and clammy patient. His hemoglobin had dropped from 14 g/dL on admission to 6 g/dL. A bedside ultrasound identified pelvic free fluid. An exploratory laparotomy revealed hemoperitoneum, and over 2 500 ml of blood and clot, a large hematoma was identified that was occupying the transvers colon mesentery and retroperitoneum. A clot was removed, revealing ruptured gastroduodenal artery aneurysm with active hemorrhage. The opening was isolated and closed. The contents were returned to the abdomen, which was irrigated and closed. Postoperative laboratory evaluation revealed hyperamylasemia (1543 IU/L, Normal Value (NV) = 15-95 IU/L). He remained normotensive throughout his 8-day hospitalization and was discharged home in good condition. In conclusion, gastroduodenal artery aneurysm rupture is a rare and patients can present with nonspecific symptoms. Rapid diagnosis, localization, and surgical or endovascular intervention are necessary to avoid devastating consequences.
胃十二指肠动脉（GDA）动脉瘤是一种罕见的疾病，在文献报道的3000例所有内脏动脉瘤中仅占1.5%。我们报告一例55岁的白种男性，诊断为右腹股沟疝。他因手术治疗入住我们科室。他有高血压和心绞痛病史。第二天进行了手术。术中诊断为右侧腹股沟斜疝。采用霍尔斯特德技术治疗原发性腹股沟疝。术后即刻病情进展良好，收缩压120 mmHg，脉搏68次/分钟。术后16小时，患者全身状况突然改变，出现血流动力学休克体征，收缩压60 mmHg，心动过速110次/分钟。体格检查发现患者面色苍白、冰冷且潮湿。他的血红蛋白从入院时的14 g/dL降至6 g/dL。床边超声检查发现盆腔有游离液体。剖腹探查发现腹腔积血，有超过2500毫升的血液和血凝块，发现一个巨大血肿占据横结肠系膜和腹膜后间隙。清除血凝块后，发现胃十二指肠动脉动脉瘤破裂并伴有活动性出血。对破裂口进行分离并缝合。将内容物回纳至腹腔，冲洗并关闭腹腔。术后实验室检查显示高淀粉酶血症（1543 IU/L，正常值（NV）=15 - 95 IU/L）。他在住院8天期间血压一直正常，出院时情况良好。总之，胃十二指肠动脉动脉瘤破裂是罕见的，患者可能出现非特异性症状。快速诊断、定位以及手术或血管内介入治疗对于避免灾难性后果是必要的。
