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致命性急腹症的罕见病因——腹腔动脉动脉瘤

Rare cause of fatal acute abdomen-celiac artery aneurysm.

作者信息

Rajahram Dhadchayini, Satchithanantham Vinojan, Veerasingam Suthagaran, Tharmalingam Thulasi

机构信息

Faculty of Medicine, University of Jaffna, Sri Lanka.

Faculty of Medicine, University of Jaffna, Sri Lanka.

出版信息

Int J Surg Case Rep. 2023 Aug;109:108546. doi: 10.1016/j.ijscr.2023.108546. Epub 2023 Jul 21.

Abstract

INTRODUCTION

Aneurysm of the celiac artery is a rare type of visceral artery aneurysm with an incidence of 0.1 %2%, but it carries a definitive risk of rupture. Neurofibromatosis type 1 (NF-1) has a remarkable association with a spectrum of arterial diseases, including an occlusive or aneurismal disease. Less often it affects celiac arteries.

PRESENTATION OF CASE

Here we present a case of rupture of celiac artery aneurysm in a patient NF-1 who presented with sudden onset of acute severe epigastric pain with tenderness and guarding in the epigastric region. Computed tomography (CT) scan revealed celiac artery aneurysm with evidence of retroperitoneal hematoma. As the patient became unstable, we performed emergency laparotomy in the best interest of the patient in our setting, and we barely controlled the source of bleeding. Unfortunately, we could not save the patient as he developed disseminated intravascular coagulation due to a massive blood transfusion.

DISCUSSION

Visceral artery aneurysm should be considered in patients present with an acute abdomen with anemia. As neurofibromatosis is associated with a spectrum of a vascular disease, vascular screening needs to be considered.

CONCLUSION

Even though celiac artery aneurysm is rare, it should be considered as one of the prompt differential diagnoses when patients present with an acute abdomen with anemia to prevent a fatal outcome.

摘要

引言

腹腔干动脉瘤是一种罕见的内脏动脉瘤,发病率为0.1%至2%,但具有明确的破裂风险。1型神经纤维瘤病(NF-1)与一系列动脉疾病显著相关,包括闭塞性或动脉瘤性疾病。它较少累及腹腔干动脉。

病例介绍

在此,我们报告一例NF-1患者的腹腔干动脉瘤破裂病例,该患者突发急性严重上腹部疼痛,上腹部有压痛和肌卫。计算机断层扫描(CT)显示腹腔干动脉瘤并伴有腹膜后血肿迹象。由于患者病情不稳定,在我们的医疗环境中,为了患者的最大利益,我们进行了急诊剖腹手术,勉强控制了出血源。不幸的是,由于大量输血导致患者发生弥散性血管内凝血,我们未能挽救该患者。

讨论

对于出现急性腹痛并伴有贫血的患者,应考虑内脏动脉瘤。由于神经纤维瘤病与一系列血管疾病相关,需要考虑进行血管筛查。

结论

尽管腹腔干动脉瘤罕见,但当患者出现急性腹痛并伴有贫血时,应将其视为快速鉴别诊断之一,以防止出现致命后果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/00a3/10369464/660f5a61514b/gr1.jpg

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