炎症性腹部大動脈瘤の1手術治験例

A case report:Surgical treatment of inflarnmatory abdominal aortic aneurysm

　炎症性腹部大動脈瘤に対する一手術治験を報告する。症例は53歳，男性。腹痛にて入院した。赤沈亢進，白血球増多，CRP陽性と炎症所見を認めた。腹部のコントラストCTにて腹部人動脈瘤を認め，瘤壁は肥厚しマントル状を呈した。破裂性大動脈瘤の疑いにて手術を施行した。大動脈瘤は周囲の臓器と強度に癒着し，左腎静脈を圧迫閉塞し，左尿管と左精巣静脈を取り巻いて肥厚しており，破裂の所見は認められなかった。瘤を可能なだけ切除し人工血管にて置換した。術後疼痛は消失し経過良好で退院した。瘤壁の組織像は慢性炎症を呈し，炎症性腹部大動脈瘤と診断した。有痛性腹部大動脈瘤で血液検査上炎症所見を認める症例はCT検査を行い，マントル状に肥厚した瘤壁を呈する場合本症と考えられる。治療は瘤切除人工血管置換術が適切である。

A 53-year-old man was hospitalized with chronic abdominal pain. A CT scan was performed and de-monstrated an aortic aneurysm surrounded by a soft tissue mantle. In the laparotomy, extensive fibrotic adhesions between the aneurysm and the duodenum were discovered. This made mobilization of the duo-denum and the left renal vein difficult. The aortic wall was white, thickened, and surrounded with dense fibrous tissue. The aneurysm was replaced by a Dacron graft. Histology of the fibrous tissue showed the features of chronic in flammation. He had no abdominal pain after the operation, and he was discharged in good health. In the preoperative diagnosis of inflammatory aneurysms, the CT scan is useful. We are of the opinion that the preferred treatment for inflammatory aneurysm is aneurysmec-tomy (or aneurysmorraphy) plus grafting.