因肠系膜下动脉与主动脉移植物吻合部位形成继发性主动脉肠瘘导致心脏骤停的救命病例。
Life-saving case of cardiopulmonary arrest by secondary aortoenteric fistula formed in the anastomotic site between the inferior mesenteric artery and aortic graft.
作者信息
Yagi Masayuki, Aiboshi Junichi, Kojima Mitsuaki, Yoshikawa Shunsuke, Morishita Koji, Kaji Masahito, Otomo Yasuhiro
机构信息
Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan.
出版信息
Acute Med Surg. 2022 Mar 25;9(1):e2744. doi: 10.1002/ams2.744. eCollection 2022 Jan-Dec.
BACKGROUND
Secondary aortoenteric fistula is a fatal cause of gastrointestinal bleeding after aortic reconstructive surgery with a prosthesis. In most cases, the proximal suture line is involved. We herein report a rare case in which the fistula formed between the suture line of inferior mesenteric artery reimplantation and the jejunum.
CASE PRESENTATION
An 82-year-old man was transferred to our hospital due to hematemesis with severe hypovolemic shock. Although he fell into cardiopulmonary arrest, immediate resuscitation achieved return of spontaneous circulation. As his surgical history of aortic reconstruction and computed tomography findings suggested potential secondary aortoenteric fistula, emergency surgery was carried out. The anastomosis between the inferior mesenteric artery and aortic graft was communicating with the jejunum. Partial jejunal resection was undertaken, and the aortic graft was replaced.
CONCLUSION
The anastomosis between the inferior mesenteric artery and aortic graft in the previous aortic replacement can become the site of secondary aortoenteric fistula.
背景
继发性主动脉肠瘘是主动脉人工血管重建术后胃肠道出血的致死原因。在大多数情况下，近端缝合线受累。我们在此报告一例罕见病例，瘘管形成于肠系膜下动脉再植的缝合线与空肠之间。
病例介绍
一名82岁男性因呕血伴严重低血容量性休克转入我院。尽管他陷入心肺骤停，但立即复苏使自主循环恢复。由于他有主动脉重建手术史且计算机断层扫描结果提示可能存在继发性主动脉肠瘘，遂进行了急诊手术。肠系膜下动脉与主动脉移植物之间的吻合口与空肠相通。进行了部分空肠切除术，并更换了主动脉移植物。
结论
既往主动脉置换术中肠系膜下动脉与主动脉移植物之间的吻合口可成为继发性主动脉肠瘘的部位。
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