Lim Ji Yeon, Choi Yoon Hee, Lee Sun Hwa
Department of Emergency Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
Clin Exp Emerg Med. 2016 Jun 30;3(2):112-115. doi: 10.15441/ceem.15.029. eCollection 2016 Jun.
Epigastric pain is a common symptom in the emergency department. Most epigastric pain is not fatal, except in acute myocardial infarction, aortic dissection, and abdominal aneurysm rupture. Epigastric pain can also be the only symptom of isolated spontaneous gastric artery dissection. We report the case of a 51-year-old woman diagnosed with neurofibromatosis who initially presented with only epigastric pain. She was initially misdiagnosed with gastritis, treated conservatively, and discharged. Two hours later, she returned to the emergency department with persistent epigastric pain and rebound tenderness in the epigastric area. Angiography revealed a left hepatic arterial aneurysm and right gastric artery dissection, which were subsequently embolized. Although extremely rare, patients presenting with epigastric pain at risk of vasculopathies should be considered for isolated spontaneous gastric artery dissection. Early recognition and definitive therapy lead to a favorable outcome.
上腹部疼痛是急诊科的常见症状。除急性心肌梗死、主动脉夹层和腹主动脉瘤破裂外，大多数上腹部疼痛并非致命性的。上腹部疼痛也可能是孤立性自发性胃动脉夹层的唯一症状。我们报告一例51岁诊断为神经纤维瘤病的女性病例，其最初仅表现为上腹部疼痛。她最初被误诊为胃炎，接受保守治疗后出院。两小时后，她因上腹部持续疼痛和上腹部反跳痛返回急诊科。血管造影显示左肝动脉瘤和右胃动脉夹层，随后进行了栓塞治疗。尽管极为罕见，但对于有血管病变风险且表现为上腹部疼痛的患者，应考虑孤立性自发性胃动脉夹层。早期识别和确定性治疗可带来良好预后。
