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出血性ショックを起こした自然発生的な脾動脈偽動脈瘤破裂
Spontaneous Splenic Artery Pseudoaneurysm Rupture Causing Hemorrhagic Shock.
PMID: 32601561 PMCID: PMC7317116. DOI: 10.7759/cureus.8286.
抄録
脾動脈偽動脈瘤(SAP)は、急性腹痛の病因としては珍しく、タイムリーに診断するためには高度な臨床的疑いを必要とする。現在のところ、救急医療の文献には自然発症したSAP破裂の報告はない。我々は、腹部のSAP.A.A.C.T.O.G.A.ANgiographyscanにより、血尿膜とSAP破裂を明らかにした二次的な急性腹痛を呈した男性の症例を報告する。本症例では、急性腹痛患者における鑑別診断の幅広いリストの重要性を強調し、救急医が緊急状態を特定し、初期の安定化、蘇生、管理を指示することの重要性を強調した。
Splenic artery pseudoaneurysm (SAP) is an uncommon etiology of acute abdominal pain, requiring a high degree of clinical suspicion to diagnose in a timely manner. There are currently no reports of spontaneous SAP ruptures in the emergency medicine literature. We report a case of a man who presented with acute abdominal pain secondary to an SAP. A computed tomography angiography scan of the abdomen revealed a ruptured SAP with hemoperitoneum. He successfully underwent emergency laparotomy and surgical ligation of his SAP with splenectomy. SAP rupture remains an under-recognized etiology of abdominal pain, even though it is the most frequent type of visceral pseudoaneurysm. Our case herein reinforces the importance of a broad list of differential diagnoses in the patient with acute abdominal pain, as well as the importance of the emergency physician in identifying an emergent condition and then directing the initial stabilization, resuscitation, and management.
Copyright © 2020, Montrief et al.