Hatogai Ken, Nakazawa Atsushi, Takita Maiko, Kishino Ryouhei, Seki Eri, Iwasaki Eisuke, Izumiya Motoko, Maeda Norio, Motegi Katsuhiko, Mukai Kiyoshi, Tsukada Nobuhiro
Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Japan.
Nihon Shokakibyo Gakkai Zasshi. 2012 Feb;109(2):247-54.
A 41-year-old man was admitted to our hospital with gastrointestinal bleeding. Esophagogastroduodenoscopy revealed a submucosal protrusion with erosion in the duodenal bulb which was thought to be the bleeding source. Dynamic CT scan, ultrasonography and angiography of the abdomen revealed a hepatic artery aneurysm and a dilated celiac artery that dissected from its origin. Although we considered percutaneous transcatheter arterial embolization with metallic coils, we chose surgical resection and vascular reconstruction to prevent hepatic ischemia resulting from interruption of collateral circulation. On the 8(th) day, hepatic artery aneurysmectomy and revascularization with a great saphenous vein was carried out without any severe complication. The pathological specimen demonstrated segmental arterial mediolysis.
一名41岁男性因胃肠道出血入院。食管胃十二指肠镜检查发现十二指肠球部有一个伴有糜烂的黏膜下隆起，考虑为出血来源。腹部动态CT扫描、超声检查和血管造影显示肝动脉瘤和从起始处剥离的扩张的腹腔动脉。尽管我们考虑过用金属线圈进行经皮经导管动脉栓塞，但为防止因侧支循环中断导致肝缺血，我们选择了手术切除和血管重建。在第8天，进行了肝动脉瘤切除术并用大隐静脉进行血管重建，未出现任何严重并发症。病理标本显示节段性动脉中层溶解。
