sato toshimitsu

症例1は68歳男性で、糖尿病の既往があった。心房細動で植込み型除細動器(ICD)挿入のためワルファリン休薬中で、ICD挿入4日目に突然両下肢脱力、冷感を認め、大腿動脈以下の拍動を触知せず、CTで腹部大動脈終末部に多量の血栓を認め、発症3時間後に血栓除去術を行った。術後2週目に再度両下肢の虚血症状が出現し、CT上両下肢動脈塞栓の診断で再度血栓除去術を行った。その後、左鼠径部の創感染をきたし、糖尿病のため感染コントロールは困難で、左総大腿動脈が破綻して出血し、手術的止血も効果なく、全身状態の悪化とARDS発症で人工呼吸管理を行うも、初回手術後54日目に呼吸不全で死亡した。なお、創感染部と血管壁からCitrobacter Koseriが検出された。症例2は71歳女性で、突然の両下肢脱力で受診した。大腿動脈以下の拍動を触知せず、CTで腹部大動脈終末部に多量の血栓を認め、発症8時間後に血栓除去術を行った。術後経過は良好で術後14日目に独歩退院した。

<strong>Background:</strong> Gastroduodenal artery aneurysm is very rare among visceral aneurysms. Once it ruptures, however, the outcome can be fatal. We report treatment of a case of non-ruptured gastroduodenal artery aneurysm.<br><strong>Case:</strong> The patient was a 76-year-old man with a past history of only hypertension. He was introduced to our hospital to examine a pulsatile mass on the right upper abdomen accidentally detected by ultrasonography by a local doctor. Based on the findings of computed tomography and angiography we diagnosed gastroduodenal artery aneurysm with a maximum diameter of about 5 cm. On angiography, we found the proximal neck of aneurysm to be very short and could not perform interventional radiology (IVR). We decided to perform a surgical operation.<br><strong>Result:</strong> We performed laparotomy under general anesthesia, and the common hepatic artery (CHA), right and left hepatic artery (RHA, LHA), and gastroduodenal artery (GDA) were clamped. The orifice of the GDA was sutured. Reconstruction of the hepatic artery was performed with direct anastomosis of the CHA and the proper hepatic artery (PHA).<br>Arterial blood flow to the liver was clearly detected by ultrasonography both intraoperatively and postoperatively, and on laboratory investigations, the indicators of liver function, alanine aminotransferase, aspartate transaminoferase etc. were normalized by the third postoperative day.<br><strong>Conclusion:</strong> We report a rare case of non-ruptured gastroduodenal artery aneurysm treated successfully with surgical repair.

<strong>Background:</strong>Duodenal obstruction caused by abdominal aortic aneurysm (AAA) and abdominal wall or superior mesenteric artery (SMA), is relatively rare. We report 2 cases of obstruction of duodenum sandwiched by AAA and SMA or abdominal wall and a review of literatures. <strong>Cases:</strong> Case 1: the 81-year-old man, with a chief complaint of frequent vomiting. He was referred by a local doctor. On computed tomography (CT) scan, obstruction of the duodenum sandwiched by AAA (maximum diameter 75 mm) and SMA was diagnosed. Case 2: 71-year-old man with frequent vomiting after oral intake as a chief complaint. A pulsatile mass in the abdomen was found. On CT scan, the obstruction of duodenum sandwiched between the AAA (maximum diameter 65 mm) and the abdominal wall was found. <strong>Results:</strong> In both cases, bifurcated graft replacement surgery was performed and the symptoms subsided. <strong>Conclusion:</strong> Both cases of ileus due to obstruction by an AAA and abdominal wall or SAM were successfully treated.