Ha Le Dung, Imray Christopher
Warwick Medical School, Coventry, UK.
BMJ Case Rep. 2011 Jun 9;2011:bcr0220113801. doi: 10.1136/bcr.02.2011.3801.
A 55-year-old gentleman with a medical history of hypertension presented to emergency department with sudden onset of central abdominal pain and left flank pain. A CT KUB (kidney, ureter and bladder) was performed to assess the patient for a possible renal calculus and other potential gastrointestinal causes. However, an extensive aortic dissection from the arch of the aorta to the iliac arteries was detected. Hypotensive blood pressure control was started in an attempt to reduce the shear stress on the aortic wall. Unfortunately, the drop in blood pressure reduced splanchnic perfusion, resulting both duodenal perforation (secondary to duodenal ischaemia of the watershed area) and the development of acute renal failure. The patient underwent an emergency laparotomy for the perforated duodenum and biliary peritonitis. He was transferred to the intensive care unit for 18 days postsurgery for renal, respiratory, nutritional and cardiovascular support and was finally discharged home.
一名有高血压病史的55岁男性因突发中腹部疼痛和左侧胁腹疼痛就诊于急诊科。行CT KUB（肾脏、输尿管和膀胱）检查以评估患者是否存在肾结石及其他潜在的胃肠道病因。然而，发现了从主动脉弓到髂动脉的广泛主动脉夹层。开始进行低血压血压控制，试图降低主动脉壁上的剪切力。不幸的是，血压下降导致内脏灌注减少，进而引发十二指肠穿孔（继发于分水岭区域十二指肠缺血）和急性肾衰竭。患者因十二指肠穿孔和胆汁性腹膜炎接受了急诊剖腹手术。术后他被转入重症监护病房18天，接受肾脏、呼吸、营养和心血管支持，最终出院回家。
