サルモネラ菌による感染性腹部大動脈瘤の1治験例

A Case of Successful Surgical Treatment of an Infected Abdominal Aortic Aneurysm due to Salmonella

要旨　感染性腹部大動脈瘤の1例を経験したので報告する．患者は58歳，男性．発熱，腰痛を主訴に来院．白血球6,600/mm3，CRP8.9mg/dl，血液培養にてサルモネラ菌を検出，腹部CTにて腹部大動脈瘤を認め，感染性腹部大動脈瘤が疑われた．抗生剤投与を行っていたが，入院13日目にCT上破裂を認めたため緊急的に手術を施行した．まず左腋窩動脈-左大腿動脈バイパス，大腿-大腿動脈バイパスを施行後開腹し，感染瘤を摘除して大網を同部に充填した．切除標本よりサルモネラ菌を検出した．術後抗生剤治療により感染所見は次第に沈静化し，軽快退院した．

Summary

　A 58-year-old man with the complaint of fever and lumbago was admitted to our hospital for further examination. Initial abdominal CT suggested an abdominal aortic aneurysm and the blood culture revealed Salmonella. Although he was treated with antibiotics for his presumed infected abdominal aortic aneurysm, a second abdominal CT showed an increase in size and rupture of the aneurysm on the 13th hospital day. He underwent emergency operation consisting of left axillofemoral and femorofemoral bypass and excision of the infected abdominal aortic aneurysm. Salmonella was isolated from the excised specimen. After subsequent intravenous antibiotic therapy,he was discharged without any evidence of infection.