Kohama Keisuke, Ito Yusuke, Kai Tatsuro, Kotani Joji, Nakao Atsunori
Senri Critical Care Medical Center Saiseikai Senri Hospital Suita Osaka Japan.
Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Nishinomiya Japan.
Acute Med Surg. 2015 Sep 22;3(2):192-194. doi: 10.1002/ams2.157. eCollection 2016 Apr.
An 85-year-old man was admitted to the hospital, underwent laparotomy, and was diagnosed with diffuse peritonitis due to perforation of gastric ulcer. Omental patch repair was carried out. After surgery, he suddenly vomited blood and manifested hypovolemic shock. An emergency upper gastrointestinal endoscopy was carried out immediately. However, the bleeding source was not visible. Dynamic-enhanced abdominal computed tomography showed a pseudoaneurysm of the gastroduodenal artery-communicating duodenal lumen with extravasation. Next, the patient underwent angiography for embolization. However, selective arterial embolization was not successful.
Finally, duodenotomy was carried out. The fistula between the pseudoaneurysm and duodenal lumen was directly ligated. An aneurysm could be clearly identified by previous findings.
Gastroduodenal artery aneurysms are very uncommon but possibly lethal if they rupture. This life-threatening condition requires rapid diagnosis and treatment. Minimally invasive treatment is the preferred therapy for gastroduodenal artery aneurysm; however, acute care surgery should be considered without hesitation when conditions are critical.
一名85岁男性入院，接受了剖腹手术，被诊断为胃溃疡穿孔导致弥漫性腹膜炎。进行了网膜补片修补术。术后，他突然吐血并出现低血容量性休克。立即进行了紧急上消化道内镜检查。然而，出血源不可见。动态增强腹部计算机断层扫描显示胃十二指肠动脉假性动脉瘤——与十二指肠腔相通并伴有外渗。接下来，患者接受了血管造影栓塞术。然而，选择性动脉栓塞未成功。
最后，进行了十二指肠切开术。假性动脉瘤与十二指肠腔之间的瘘管被直接结扎。根据先前的检查结果可以清楚地识别出动脉瘤。
胃十二指肠动脉动脉瘤非常罕见，但破裂时可能致命。这种危及生命的情况需要快速诊断和治疗。微创治疗是胃十二指肠动脉动脉瘤的首选治疗方法；然而，在病情危急时应毫不犹豫地考虑急症手术。
