サルモネラ腸炎由来の感染性腹部大動脈瘤破裂に対する緊急手術の1例

A Successful Anatomic Reconstruction of an Infected Abdominal Aortic Aneturysm due to Salmonella Enteritis:A case report

　感染性腹部大動脈瘤は稀な疾患で，起因菌として近年の報告ではサルモネラ菌が35〜38％と最多である．今回われわれは，発熱と腹痛を主訴とした患者に対し血液学的炎症所見と腹部CT所見より後腹膜膿瘍を合併した腹部大動脈瘤を疑い，緊急手術を施行した．開腹時に腹腔内に膿瘍は認めず，破裂性腹部仮性大動脈瘤を認めた．人工血管吻合部は正常組織であったためYグラフトによる解剖学的血行再建術を施行した．術後の培養・病理検査からサルモネラ腸炎由来の感染性腹部大動脈瘤と診断された．感染性腹部大動脈瘤では術後の適切なドレナージと長時間の抗生剤治療により解剖学的血行再建は可能である．また，破裂が疑われる場合には，炎症の鎮静化に拘泥せずに緊急手術を施行すべきである．

A successful operation for rupture of an infected abdominal aortic aneurysm (IAAA) was reported. At present, many reports show that salmonella is the most common bacteria that causes IAAA. The patient was a 61-year-old male, who was admitted with low grade fever and abdominal pain. Preoperative enhanced abdominal computed tomography demonstrated a retroperitoneal abscess and an abdominal aortic aneur-ysm. An emergency operation was performed for rupture of this aneurysm and retroperitoneal drainage. When the retroperitoneam was opened, no abscess for-mation was observed, but a ruptured abdominal aortic pseudoaneurysm was found. Anatomical reconstruction using a Y-shaped synthetic graft was carried out. Postoperative bacterial and pathological exami-nations revealed a ruptured IAAA due to salmonella enteritis.

We concluded that the emergency anatomical recon-struction, along with administration of prolonged appro-priate antibiotics and postoperative drainage, may help save the patient's life in spite of retroperitoneal infec-tion. When IAAA is suspected to have rupture, an emergency operation should be performed even if hematological inflammatory change such as high value of CRP is found.