Shizuku Tatsunori, Yamaguchi Hiroyuki
Internal Medicine, US Naval Hospital Okinawa, Okinawa, JPN.
Rheumatology, Funabashi Municipal Medical Center, Funabashi, JPN.
Cureus. 2024 Nov 7;16(11):e73193. doi: 10.7759/cureus.73193. eCollection 2024 Nov.
A 77-year-old woman with a history of endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm (AAA) presented with melena. She had been recently diagnosed with IgG4-related periaortitis and started on prednisone. Physical examination revealed pallor conjunctiva and melena on the rectal examination, with laboratory results indicating anemia (hemoglobin: 7.4 g/dl). Abdominal CT showed air within the aneurysmal sac, and endoscopy confirmed an aortoduodenal fistula. The patient underwent urgent stent removal, vessel replacement, and duodenal repair. She recovered well and was discharged on day 30 with ongoing prednisone therapy. The risk of fistula formation in IgG4-related periaortitis necessitates careful monitoring, especially in patients with pre-existing aortic pathology.
一名77岁女性，曾因腹主动脉瘤接受血管内动脉瘤修复术（EVAR），现出现黑便。她最近被诊断为IgG4相关性主动脉周炎，并开始使用泼尼松治疗。体格检查发现结膜苍白，直肠检查有黑便，实验室检查结果显示贫血（血红蛋白：7.4 g/dl）。腹部CT显示动脉瘤腔内有气体，内镜检查证实存在主动脉十二指肠瘘。患者接受了紧急支架移除、血管置换和十二指肠修复手术。她恢复良好，在第30天出院，继续接受泼尼松治疗。IgG4相关性主动脉周炎形成瘘的风险需要仔细监测，尤其是在已有主动脉病变的患者中。
