Nonami Y, Okazaki Y, Yamashiro T, Ogoshi S
Department of Surgery II, Kochi Medical School, Japan.
Cardiovasc Surg. 1995 Apr;3(2):227-9. doi: 10.1016/0967-2109(95)90901-g.
The operative treatment of chronic contained rupture of a saccular abdominal aortic aneurysm (AAA) with retroperitoneal haematoma is reported. A 62-year-old man presented with a painless abdominal mass and intermittent claudication. He had an episode of severe abdominal pain about 2 years before admission. A giant retroperitoneal neoplasm was initially suspected, based on computed tomography. However, magnetic resonance imaging, angiography and colour Doppler sonography demonstrated chronic contained rupture of an AAA. A punched-out oval defect (width 3.5 cm x length 4.5 cm) that was thought to connect the thrombosed aneurysm to an organized retroperitoneal haematoma was discovered in the posterior wall of the bifurcation of the aorta at laparotomy. An infrarenal aortobiexternal iliac Y-graft with bypass to the left femoral artery was placed without removing the aneurysm or haematoma. Recovery was uneventful. The retroperitoneal haematoma appeared smaller on computed tomography about 1 year after operation. This case fulfilled the criteria for chronic contained rupture of an AAA proposed by Jones and associates.
本文报道了对伴有腹膜后血肿的腹主动脉瘤（AAA）慢性局限性破裂的手术治疗。一名62岁男性患者，出现无痛性腹部肿块和间歇性跛行。入院前约2年曾有一次严重腹痛发作。基于计算机断层扫描，最初怀疑为巨大腹膜后肿瘤。然而，磁共振成像、血管造影和彩色多普勒超声检查显示为AAA慢性局限性破裂。剖腹手术时，在主动脉分叉后壁发现一个椭圆形穿孔缺损（宽3.5厘米×长4.5厘米），认为该缺损将血栓形成的动脉瘤与有组织的腹膜后血肿相连。未切除动脉瘤或血肿，植入了带左股动脉旁路的肾下腹主动脉-双侧髂外动脉Y型移植物。恢复过程顺利。术后约1年的计算机断层扫描显示腹膜后血肿变小。该病例符合Jones及其同事提出的AAA慢性局限性破裂标准。
