切迫破裂が危惧された感染性上腸間膜動脈瘤に対してコイル塞栓術を施行した1例

A case of enforcing coil embolization for an infected aneurysm of the superior mesenteric artery with fear of imminent rupture

上腸間膜動脈瘤は腹部内臓動脈瘤の5.5％で認められる比較的まれな疾患である^1）。原因は感染性のものが60％前後と多く，ほかに動脈硬化性，解離性が多いとされている^2）。未破裂の感染性上腸間膜動脈瘤に対する治療法として，外科的治療と経カテーテル動脈塞栓術（transcatheter arterial embolization：TAE）があり，どちらを第一選択とするか，一定の見解は得られていない。今回我々は，切迫破裂が危惧された感染性上腸間膜動脈瘤に対してTAEを施行し，経過が良好であった症例を経験したので，若干の文献的考察を加えて報告する。

We report a man in his 40s complained fever and back pain. Osler nodules were found at the end of limbs and contrast–enhanced CT revealed multiple infarctions in the brain, kidneys, and spleen, therefore he was diagnosed with infective endocarditis. Echocardiography revealed severe aortic valve regurgitation, so emergency aortic valve replacement surgery was performed. On day 10, he complained abdominal pain. Contrast–enhanced CT revealed infected aneurysm of the superior mesenteric artery, and impending rupture was suspected. Transarterial coil embolization was performed, and the progress was good. Although there is no consensus regarding the use of transarterial coil embolization for infected aneurysm, we believe that transarterial coil embolization can be reasonable treatment for infected aneurysm of superior mesenteric artery.