Mozafar Mohammad, Mohebbi Hossein, Parvas Ehsan, Sakhaei Delaram, Zarafshani Mohammadkian, Ilkhani Saba
Division of Vascular & Endovascular Surgery, Department of General & Vascular Surgery, Shohada - Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Kermanshah University of Medical Sciences, Kermanshah, Iran.
Int J Surg Case Rep. 2023 Aug;109:108622. doi: 10.1016/j.ijscr.2023.108622. Epub 2023 Aug 9.
Vascular complications like superior mesenteric artery (SMA) thrombosis and pancreaticoduodenal artery (PDA) pseudoaneurysm carry high morbidity and mortality. SMA provides the primary arterial supply to the small intestine and ascending colon. PDA aneurysms are extremely rare, accounting for only 2 % of all visceral artery aneurysms. We present a rare case of SMA thrombosis with concomitant PDA pseudoaneurysm.
Herein is the case of a 60-year-old male who presented with rectorrhagia, persistent generalized abdominal pain. After being diagnosed with colitis and mesenteric artery thrombosis based on a computed tomography (CT) scan, he was discharged from the hospital with rivaroxaban and mesalazin. However, he had to return to the hospital due to worsening of the symptoms. After a proper workout, SMA artery thrombosis with a concomitant PDA pseudoaneurysm was diagnosed for him. Therefore, he underwent surgery to stent the thrombosis and coil the pseudoaneurysm. His symptoms dramatically improved after the treatment.
Angiography is the diagnostic and, with embolization, therapeutic procedure of choice, with surgery as a backup if embolization fails. However, even with these procedures, the mortality rate is high if the pseudoaneurysm ruptures.
In order to carry out the proper choice of surgical treatment before further complications occur, SMA thrombosis and PDA pseudoaneurysms must be investigated in each patient presenting with nonspecific abdominal pain, regardless of the risk factors.
肠系膜上动脉（SMA）血栓形成和胰十二指肠动脉（PDA）假性动脉瘤等血管并发症具有较高的发病率和死亡率。SMA为小肠和升结肠提供主要动脉血供。PDA动脉瘤极为罕见，仅占所有内脏动脉瘤的2%。我们报告一例罕见的SMA血栓形成合并PDA假性动脉瘤病例。
本文报告一名60岁男性，出现直肠出血、持续性全腹痛。基于计算机断层扫描（CT）诊断为结肠炎和肠系膜动脉血栓形成后，他出院时服用利伐沙班和美沙拉嗪。然而，由于症状恶化，他不得不再次入院。经过适当检查，诊断为他患有SMA动脉血栓形成合并PDA假性动脉瘤。因此，他接受了手术，对血栓进行支架置入并对假性动脉瘤进行弹簧圈栓塞。治疗后他的症状显著改善。
血管造影是诊断的首选方法，若进行栓塞则是治疗的首选方法，若栓塞失败则以手术作为备用方案。然而，即使采取这些措施，如果假性动脉瘤破裂，死亡率也很高。
为了在进一步并发症发生前正确选择手术治疗方法，对于每一位出现非特异性腹痛的患者，无论有无危险因素，都必须对SMA血栓形成和PDA假性动脉瘤进行检查。
