空腸動脈瘤破裂に対し腹腔鏡補助下手術にて救命しえた1例

A case of ruptured aneurysm of the jejunum causing massive intestinal bleeding

◆要旨：患者は17歳，女性．突然の下腹部痛とふらつきで来院し，救急外来にて大量下血，ショック状態となった．大量輸液にて全身状態が改善したところで，造影CT検査・血管造影検査にて空腸枝動脈の腸管内漏出を伴う動脈瘤破裂と診断された．動脈瘤にコイル塞栓を行い，血管カテーテルを留置したまま緊急腹腔鏡補助下腸切除術となった．術中に血管カテーテルからの色素注入と術中透視を併用することで，迅速かつ的確に動脈瘤の位置を確認した．さらに,腹腔鏡操作を用いることで低侵襲かつ効果的に治療・救命しえた．小腸動脈瘤の報告例63例に自験例を加えた64例について，背景，出血源検索方法，治療方法を検討した．

　We have reported case of ruptured small intestinal aneurysm causing life-threatening and catastrophic intestinal hemorrhage presented in a 17-year-old female. The patient was admitted to our hospital with sudden abdominal pain and dizziness. An enhanced CT scan and angiography showed a ruptured aneurysm with bleeding in the small intestine. After a coil embolization of the ruptured aneurysm, an emergency operation by lapaloscopic surgery was performed. At the operation, the source of bleeding was detected and resected , using a vascular catheter inside the marginal small bowel artery and diaphanoscopy. The patient was effectively rescued with minimal invasion. The article described the sixty- fourth patient of a small intestinal aneurysm. In addition to the clinical features, the diagnostic and therapeutic modalities required in the management of these rare lesions were also discussed.