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Kokyu to Junkan Volume 44, Issue 4 （April 1996）

呼吸と循環 44巻4号（1996年4月発行）

Japanese English

症例

緊急手術で救命しえた大動脈炎症候群に伴う腹部大動脈瘤破裂の1例 A Case of Rupture of all Abdominal Aortic Aneurysm with Takayasu's Arteritis 岩間義孝 ¹ , 加納達二 ¹ , 相川由美子 ¹ , 小林清亮 ¹ , 粕谷秀樹 ¹ , 尾崎治夫 ¹ , 石和久 ² , 渡邊隆 ³ , 笹栗志朗 ³ , 細田泰之 ³ Yoshitaka Iwama ¹ , Tatsuji Kanoh ¹ , Yumiko Aikawa ¹ , Seiryou Kobayashi ¹ , Hideki Kasuya ¹ , Haruo Ozaki ¹ , Kazuhisa Ishi ² , Takashi Watanabe ³ , Shirou Sasaguri ³ , Yasuyuki Hosoda ³ ¹順天堂大学医学部附属順天堂浦安病院内科 ²順天堂大学医学部附属順天堂浦安病院検査科 ³順天堂大学医学部胸部外科 ¹Department of Internal Medicine, Juntendo Urayasu Hospital, School of Medicine, Juntendo University ²Department of Clinical Laboratory, Juntendo Urayasu Hospital ³Department of Thoracic Surgery, School of Medicine, Juntendo University キーワード：大動脈炎症候群 , 腹部大動脈瘤破裂 , 緊急手術 , aortitis syndrome(Takayasu's arteritis) , rupture of the abdominal aortic aneurysrn , emergency operation Keyword: 大動脈炎症候群 , 腹部大動脈瘤破裂 , 緊急手術 , aortitis syndrome(Takayasu's arteritis) , rupture of the abdominal aortic aneurysrn , emergency operation pp.427-431

発行日 1996年4月15日 Published Date 1996/4/15

DOI https://doi.org/10.11477/mf.1404901240

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　症例は56歳，女性．16歳時原因不明の高熱を来し，左橈骨動脈触知不能となり，高血圧も指摘され，49歳時精査．大動脈炎症候群と診断し，ステロイド剤投与により炎症所見は消褪したが，CT,DSA検査で腹部大動脈瘤を認めた．56歳時，動脈瘤径増大傾向のため血管造影を施行したところ，腹部大動脈から総腸骨動脈にかけて多発性の拡張性病変を認め，最大のものは腎門部を中心とした横長径9×14cmの嚢状動脈瘤であった．近日手術予定であったが，動脈瘤破裂を来し緊急手術となり，大動脈人工血管置換術を行った．術後，腎不全，虚血性腸炎，四肢不全麻痺など合併するも軽快した．

In addition to occlusive lesions, since the 1960's a number of cases of Takayasu's arteritis accompanying dilative or aneurysmal lesions of the aorta and its main branches have been reported. Such lesions have been considered important manifestations of this disease. It has been reported by various authors that incidence of such dilative or aneurysmal lesions in this disease is 4.6~25%.

We encountered a case of rupture of an aneurysm of the abdominal aorta with Takayasu's arteritis in which the patient was able to be rescued by an emergency operation. A 56-year-old woman who had a history of fever of unknown origin at 16 years of age was admit-ted to our hospital. She was aware of pulselessness of the left radial artery and was noticed to have hyperten-sion at 34 years of age. She was diagnosed as having Takayasu's atreritis and had been treated with corticos-teroid therapy. In spite of the decrease of inflammation, we confirmed by angiography the presence of a saccular aneurysm of the abdominal aorta at the level of renal arteries and occlusion of the left subclavian artery. At the age of 56, aortography revealed marked dilation of the aneurysm of the abdominal aorta to a size of 9 cm in diameter. Although we made plans for a reconstruc-tive operation for the aneurysm of the abdominal aorta, she was carried to the emergency department of ourhospital, where we were obliged to perform an emer-gency operation because the aneurysm had perforated spontaneously. The operation was successful but the post-operative course was complicated with renal fail-ure, ischemic colitis and paraplegia. Eventually, she gradually recovered and was discharged on foot.