- 期刊
主動脈腸道瘻管一臨床罕見之上消化道出血：二病例報告
Aortoeneetric Fistula – Rare upper gastrointestinal Bleeding: Two Cases Report
摘要
主動脈腸道瘻管是一種罕見且不易診斷的併發症，病人常表表大量消化道出血併發休克而致命。我們提出兩例病案討論：第一例三十九歲男性病患，因為突然解大量血便，頭暈冒冷汗，至本院求診。理學檢查發現病人意識清醒，血壓偏低，脈搏過速，結膜蒼白，鼻胃管引流出大量鮮血，內視鏡及核子醫學掃瞄皆未能找到出血點。由於內科保守治療無法有效止血，遂緊急進行剖腹探查，在十二指腸第四部分有一6公分大小之動脈瘤，與十二指腸相交通，證實是主動脈十二指腸瘻管。第二例六十三歲男性病患，因食道癌出現吞嚥困難，體重減輕，接受腫瘤切除暨食道胃吻合手。開力後第十一天，突然吐大量鮮血，意識不清，血壓偏低，心搏過慢，由於失血過多，生命徵象不穩定，立即剖腹探查，發現在食道胃吻合處後壁鄰接胸主動脈的地方有一1公分大小之潰傷瘍，並造成兩者相交通，確定為主動脈胃瘻管。此症常有先兆出血現象，但由於出血量大，出血點不易確定。內科止血術常失敗，若有高危險因素，應儘早剖腹冶療。
並列摘要
Aortoenteric fistula is rarely considered as the source of gastrointestinal hemorrhage. It often causes life-threatening shock. We report two cases: Case 1 is a 39 year old male who received emergent laparotmy because of unusual upper gastrointestinal hemorrhange with shock. Primary aoroenteric fistula was identified. Patient wad survived thereafter. Case 2 is a 63 year odl male who died of active bleeding in the 11th day after surgical removal of esophageal cancer. Secondary aortoenteric fistula wad found. High indes of clinical suspicion is tressed and surgical intervention is mandatory as soon as possible.