Taniguchi Tomoaki, Furukawa Koji, Ishii Hirohito, Kawagoe Katsuya, Sakaguchi Shuhei, Meiri Risa
Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Miyazaki, Japan.
Ann Vasc Dis. 2023 Sep 25;16(3):238-241. doi: 10.3400/avd.cr.23-00017.
A 53-year-old man suddenly developed chest and back pain while driving, resulting in an accident. Computed tomography revealed acute type A aortic dissection with malperfusion of the left lower extremity, retroperitoneal extravasation, hematoma in the anterior mediastinum, and ascites in the rectovesical pouch. Exploratory laparotomy before aortic repair revealed intestinal perforation and retroperitoneal bleeding, which were repaired, and an ascending aortic replacement was performed. Visceral trauma with active bleeding should be treated with priority, even if the need for systemic heparinization accompanies acute type A aortic dissection during surgery for aortic dissection.
一名53岁男性在驾车时突然出现胸痛和背痛,导致发生事故。计算机断层扫描显示为急性A型主动脉夹层,伴有左下肢灌注不良、腹膜后渗漏、前纵隔血肿以及直肠膀胱陷凹腹水。在进行主动脉修复之前的剖腹探查发现肠道穿孔和腹膜后出血,对其进行了修复,并实施了升主动脉置换术。即使在主动脉夹层手术期间,急性A型主动脉夹层需要全身肝素化,但伴有活动性出血的内脏创伤仍应优先处理。