Hurndall Katherine-Helen, Carpenter Holly, Sandeman Jack, Fernandes Roland
Surgery, Tunbridge Wells Hospital, Tunbridge Wells, UK.
Surgery, Medway Maritime Hospital, Kent, UK.
BMJ Case Rep. 2017 Apr 26;2017:bcr-2016-218863. doi: 10.1136/bcr-2016-218863.
A 73-year-old woman presented with a 6-hour history of sudden onset lower abdominal pain. Her comorbidities included chronic obstructive pulmonary disease and hypertension. She was under surveillance for a known thoracoabdominal aneurysm. On presentation, she was hypotensive with a systolic blood pressure of 50 mm Hg and a pulse of 60 beats per minute. On examination, she had a pulsatile mass with bruit in her right lower abdomen. Pedal pulses were palpable in both feet. Blood gas analysis revealed a metabolic acidosis with a pH of 7.21 and a lactate of 7.1. Haemoglobin remained stable between 90-100 g/dL. Her other routine blood tests were unremarkable, and blood cultures were negative. Imaging showed a ruptured right common iliac artery aneurysm into the right common iliac vein with secondary arteriovenous fistula communication. Surgical intervention was discussed with the patient but due to her frailty, it was deemed not in the patient's best interests.
一名73岁女性因突发下腹部疼痛6小时前来就诊。她的合并症包括慢性阻塞性肺疾病和高血压。她因已知的胸腹主动脉瘤正在接受监测。就诊时，她血压过低，收缩压为50毫米汞柱，脉搏每分钟60次。检查时，她右下腹部有一个搏动性肿块并伴有杂音。双脚可触及足背动脉搏动。血气分析显示代谢性酸中毒，pH值为7.21，乳酸水平为7.1。血红蛋白维持在90 - 100克/分升之间稳定。她的其他常规血液检查无异常，血培养阴性。影像学检查显示右髂总动脉瘤破裂进入右髂总静脉，继发动静脉瘘。已与患者讨论手术干预，但由于她身体虚弱，认为手术不符合患者的最大利益。
