DUODENAL OBSTRUCTION AFTER ELECTIVE ABDOMINAL AORTIC ANEURYSM REPAIR:A CASE REPORT

預定性腹主動脈瘤術後併發十二指腸阻塞之案例報告

林俊堯(Chun-Yao Lin) ； 林伯彥(Bor-Yen Lin) ； 康沛倫(Pei-Luen Kong)

《The Kaohsiung Journal of Medical Sciences》 20卷10期 (2004/10) Pp. 501-505

摘要

預定性腹主動脈瘤術後造成腸胃道併發症並非少見，發生率介於6.6%到21%，但在預定性腹主動脈瘤術後十二指腸阻塞的發生率卻可能被低估，這篇報告是關於一位78歲男性病患，在頂定性切除及原位重建腹主動脈瘤後，即使病患有排氣，於術後第九天仍發生大量含膽汁的嘔吐，在麻痺性腸阻塞的臆斷下，先給藥物治療但上消化道阻塞仍持續，術後第十二天腹部電腦斷層檢查發現胃部及十二指腸漲大，一直到十二指腸的第三部份在上腸繫膜動脈相關位置管徑突然變小，經診斷為上腸繫膜動脈症狀，經過十一天鼻胃管抽吸及靜脈營養補充的保守治療，追蹤的腹部電腦斷層檢查及上腸胃道鋇劑造影顯示無明顯十二指腸阻塞，之後病人在術後第二十九天順利出院，而且術後四個月追蹤的腹部電腦斷層檢查也無異狀。

關鍵字

主動脈瘤 ； 十二指腸阻塞 ； 上腸繫膜動脈

並列摘要

Gastrointestinal tract complications after abdominal aortic aneurysm (AAA) repair are well known. The reported frequency ranges from 6.6% to 21%. However, the incidence of duodenal obstruction following AAA has probably been underestimated. This report concerns a 78-year-old male who was admitted for elective repair of an infrarenal AAA. On the ninth postoperative day, the patient presented with large quantities of bile-stained vomitus despite passing flatus per rectum. Metoclopramide and ranitidine were given under the initial impression of paralytic ileus. However, the upper gastrointestinal obstruction persisted, and on day 12, computerized tomography (CT) revealed marked distension of the gastric tube and duodenum, down to the level of the third portion, with abrupt change of caliber at the point of the superior mesenteric artery (SMA). SMA syndrome was diagnosed. After nasogastric tube aspiration, parenteral nutrition, and 11 days of conservative treatment, abdominal CT and upper gastrointestinal series showed no apparent duodenal obstruction. The patient was discharged on the 29sh postoperative day; follow-up abdominal CT 4 months later was unremarkable.

並列關鍵字

aneurysm ； duodenal obstruction ； superior mesenteric artery