Nagao Kae, Kuroda Kohei, Fujii Masatoshi, Shirasaka Daisuke, Era Yukiko, Tsuda Kazunori, Tanaka Sanae, Miyazaki Haruka, Hiemori Akiko, Asada Yuya
Department of Gastroenterology and Hepatology, Kobe Red Cross Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2020;117(2):165-170. doi: 10.11405/nisshoshi.117.165.
A gastric ulcer was detected in a 54-year-old man who underwent upper gastrointestinal endoscopy for hematemesis. An abdominal contrasted computed tomography scan detected a splenic artery aneurysm adjacent to the gastric wall. Endoscopic hemostasis was thought to be risky owing to possible rupture of the aneurysm. Rupture of a splenic artery pseudoaneurysm due to segmental arterial mediolysis (SAM) was diagnosed by abdominal angiography, and subsequently transcatheter arterial embolization was performed. In cases of upper gastrointestinal hemorrhage, hemostasis is often performed during the emergency endoscopic examination. However, in cases of massive gastrointestinal bleeding, the possibility of a splenic artery aneurysm, in association with SAM, should be recognized. The risk of rupturing the aneurysm should be considered in selecting the most suitable treatment.
一名54岁男性因呕血接受上消化道内镜检查时发现胃溃疡。腹部增强计算机断层扫描发现胃壁附近有脾动脉瘤。由于动脉瘤可能破裂，内镜止血被认为具有风险。经腹部血管造影诊断为节段性动脉中层溶解（SAM）导致的脾动脉假性动脉瘤破裂，随后进行了经导管动脉栓塞术。在上消化道出血的病例中，通常在急诊内镜检查时进行止血。然而，在大量胃肠道出血的病例中，应认识到与SAM相关的脾动脉瘤的可能性。在选择最合适的治疗方法时应考虑动脉瘤破裂的风险。
