3 Figure 1 Contrast-enhanced computed tomogram of case 1. Right internal iliac arterial aneurysm (A) and cystic mass (C) compress the rectum (R). Figu

Size: px

Start display at page:

Download "3 Figure 1 Contrast-enhanced computed tomogram of case 1. Right internal iliac arterial aneurysm (A) and cystic mass (C) compress the rectum (R). Figu"

みがねえいさか
5 years ago
Views:

1 Online publication December 10, 2009 症例報告第 49 回総会座長推薦論文動脈腸管瘻の 3 例 1 1, 2 3 要旨 : CT Y Hartmann 2 77 CT I 3 63 CT J Jpn Coll Angiol, 2009, 49: Key words: arterio-enteric fistula, melena, endovascular aneurysm repair はじめに 3 症例 /107mmHg 86/ 36.2 C 10cm RBC /el, Hb 13.3g/dl WBC 7600/el CRP 2.2mg/ dl CT 4.5cm 5cm 6cm 1 Fig. 1 herald bleeding S GORE-TEX 1608 W. L. Gore&Associates, Inc., Arizona, USA Y Hartmann Fig. 2 2 ICU Fig. 3 Fig THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 49,

3 Figure 1 Contrast-enhanced computed tomogram of case 1.

Figure 3 Specimen of the resected rectum.

2 3 Figure 1 Contrast-enhanced computed tomogram of case 1. Right internal iliac arterial aneurysm (A) and cystic mass (C) compress the rectum (R). Figure 2 Operative procedure of case 1. Aorto-iliac artery reconstruction using a bifurcated graft (GORE-TEX 1608) and Hartmann operation were performed. Figure 3 Specimen of the resected rectum. Rupture and penetration of the aneurysm cause elevation of the rectal mucosa. H: hematoma, M: rectal mucosa Figure 4 Photomicrogram of the resected rectum. Ischemic changes of the elevated and compressed mucosa are seen, and are suspected as the cause of hemorrhage. H: hematoma, M: rectal mucosa (H&E, low magnification) 424 脈管学 Vol. 49, 2009

3 2 Figure 5 Computed tomogram of case 2. Inflammation of the periaortic tissue and duodenum (arrows) is seen. Figure 6 Operative procedure of case 2. Aortic reconstruction using tube graft (GORE-TEX 16 mm) and direct suture closure of the duodenal fistula were carried out Y 43mm TM 30mm + Gianturco Cook-Z Stent Cook Medical, Bloomington, USA 40mm 3 1 bare stent endoleak /93mmHg 94/ 36.0 C RBC /el Hb 4.6g/dl WBC 18900/el CT Fig. 5 CT Y 3 2cm Y GORE-TEX 16mm Fig. 6 脈管学 Vol. 49,

MRSA 5 7 ICU 39 2 1 3 63 2002 2004 11 Stanford B 2006 9 2008 3 12 3 17 CT 3 18 180/90mmHg 75/ 37.4 C RBC 280 10 4 /el Hb 8.8g/dl WBC 3300/ el CRP 1.

4 3 Figure 7 Contrast-enhanced computed tomogram of case 3. Pseudoaneurysm at the anastomosis of the right common iliac artery (arrow) is seen. Figure 8 Contrast-enhanced computed tomogram after stent graft deployment. There is no endoleak, however, air exists in the pseudoaneurysm (arrow). MRSA 5 7 ICU Stanford B CT /90mmHg 75/ 37.4 C RBC /el Hb 8.8g/dl WBC 3300/ el CRP 1.8mg/dl CT 6cm Fig. 7 P3008 Cordis Corporation, Warren, USA + GORE-TEX 5 mm 2 3 CT endoleak Fig. 8 7 GORE-TEX 8mm Fig. 9 ICU Fig. 10 考察 1, 脈管学 Vol. 49, 2009

2 Figure 9 Operative procedure of case 3. Femoro-femoral artery bypass (GORE-TEX 8 mm), extirpation of the graft, and resection and anastomosis of the ileum were performed.

5 2 Figure 9 Operative procedure of case 3. Femoro-femoral artery bypass (GORE-TEX 8 mm), extirpation of the graft, and resection and anastomosis of the ileum were performed. Figure 10 Microphotogram of the resected ileum. Disruption of the muscular mucosa and proper muscle layer at the fistula (arrow) is seen. MM: muscular mucosa (small arrows), MP: proper muscle layer (double arrow) (Caldesmon immunostain, low magnification) CT endoleak endoleak , 7 2/3 herald bleeding 2, 3 Herald bleeding herald bleeding 脈管学 Vol. 49,

6 3 4, 6 4, , 4, 7, 8 In situ Y I , 6, 7, 8 9 2, 9, 10 9 Hartmann 9, 11 1, 2, 9 11 in situ FF eptfe expanded polytetrafluoroethylene herald bleeding 6, 7 13 Herald bleeding 結論 3 Herald bleeding 文献 1 Matsuura K, Takahara Y, Sudo Y et al: A case of fistula of the right common iliac aneurysm to the appendix. Ann Vasc Surg, 2002, 16: Ingu A, Takagi N, Izumiyama O et al: Isolated iliac artery aneurysmocolonic fistula with pericolic abscess. Ann Vasc Surg, 2002, 16: Lawlor DK, DeRose G, Harris KA et al: Primary aorto/ iliac-enteric fistula: report of 6 new cases. Vasc Endovascular Surg, 2004, 38: Voorhoeve R, Moll FL, de Letter JAM et al: Primary aortoenteric fistula: report of eight new cases and review of the literature. Ann Vasc Surg, 1996, 10: Ueno M, Iguro Y, Nagata T et al: Aortoenteric fistula after endovascular stent grafting for an abdominal aortic aneurysm: report of a case. Surg Today, 2006, 36: van Olffen TBM, Knippenberg LHA, van der Vliet JA et al: 428 脈管学 Vol. 49, 2009

7 2 Primary aortoenteric fistula: report of six new cases. Cardiovasc Surg, 2002, 10: Tareen AH, Schroeder TV: Primary aortoenteric fistula: two new case reports and a review of 44 previously reported cases. Eur J Vasc Endovasc Surg, 1996, 12: Sweeney MS, Gadacz TR: Primary aortoduodenal fistula: manifestation, diagnosis, and treatment. Surgery, 1984, 96: Katoh J, Shindo S, Kina S et al: Rupture of an isolated internal iliac artery aneurysm into the rectum: report of a case. Surg Today, 1995, 25: Karkos CD, Oshodi TO, Vimalachandran D et al: Internal iliac aneurysm rupture into the rectum following endovascular exclusion: an unusual cause of massive lower gastrointestinal bleeding. J Endovasc Ther, 2002, 9: Ihaya A, Chiba Y, Kimura T et al: Primary aortosigmoid fistula treated by descending thoracic aortofemoral bypass. J Cardiovasc Surg (Torino), 2000, 41: Schmitt DD, Bandyk DF, Pequet AJ et al: Bacterial adherence to vascular prostheses. A determinant of graft infectivity. J Vasc Surg, 1986, 3: Nicolaou DD, Mysko WK: Enteric fistulization of a common iliac artery aneurysm: an unusual cause of gastrointestinal hemorrhage and shock. Am J Emerg Med, 1996, 14: Surgical Correction of Arterio-enteric Fistula: Report of Three Cases Kenji Sangawa, 1 Atsushi Aoki 1,2 and Yuji Ohtsuki 3 1 Department of Cardiovascular Surgery, Matsuyama Shimin Hospital, Ehime, Japan 2 Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan 3 Department of Pathology, Matsuyama Shimin Hospital, Ehime, Japan Key words: arterio-enteric fistula, melena, endovascular aneurysm repair Three cases of arterio-enteric fistula were repaired successfully. Patient 1 had a right internal iliac aneurysm with rectal fistula, and bifurcated grafting and Hartmann operation were done. Pathological examination revealed ischemic changes in elevated rectal mucosa, suggesting that herald bleeding might be due to mucosal bleeding caused by ischemia. Patient 2 had an abdominal aortic aneurysm with duodenal fistula after EVAR. Tube grafting and direct suture closure of the duodenal fistula were done. Patient 3 had anastomotic pseudoaneurysm with ileal fistula after graft replacement of the right iliac arterial aneurysm. He underwent EVAR emergently, followed by femoro-femoral bypass and resection of the graft and ileum. Their postoperative courses were uneventful. (J Jpn Coll Angiol, 2009, 49: ) 脈管学 Vol. 49, 2009 Online publication December 10,

MDCT Figure 1 Stent-grafts for abdominal aortic aneurysm. : Zenith Endovascular Graft (Cook). : Excluder (Gore). C: Powerlink (Endologix). C Figure 2

MDCT Figure 1 Stent-grafts for abdominal aortic aneurysm. : Zenith Endovascular Graft (Cook). : Excluder (Gore). C: Powerlink (Endologix). C Figure 2 Online publication pril 1, 2011 総説第 50 回総会シンポジウム 10 日本 IVR 学会 : 画像診断の進歩と血管内治療への応用腹部および胸部大動脈瘤に対するステントグラフト治療 MDCT による術前術後評価 1 1 1 2 2 要旨 : MDCT MDCT J Jpn Coll ngiol, 2011, 51: 105 111 Key words: EVR,