急性腹症─主脈剝離較少見之表現

Acute Abdomen - Uncommon Presentation of Aortic Dissectoin

楊振杰(Jenn-Jye Yang) ； 曾鴻凎(Horng-Gann Tzeng) ； 莊光輝(Guang-Huei Juang) ； 林憲宏(hsien-Hong Lin)

《慈濟醫學雜誌》 7卷2期 (1995/06) Pp. 131-135

https://doi.org/10.6440/TZUCMJ.199506.0131

摘要

主動脈剝離為一急症，其症狀表現以胸痛為主，若剝離的範圍達腹部主動脈則以併有傳至背部之上腹痛為典型表現。此病例為一28歲男性，突發DeBakey第一型主動脈剝離，而以非典型症狀來現，病人並無胸痛而單以瀰漫性腹痛表現，理學檢查腹部亦呈現瀰漫性壓痛及反彈痛，實驗室檢查除貧血及代謝性酸中毒外並無其它異樣。後經胸、腹部電腦斷層掃瞄確立診斷為DeBakey第一型主動脈剝離，其範圍延伸至腹腔動脈主幹(celiac trunk) 及上腸系膜動脈的出口。診斷確定後病人即接受主動脈重建術，術中發現腹內器官呈現泛白之色，腸道幾無蠕動，術後症狀完全緩解，因此病人之腹痛應是腹內器官廣泛缺血所致。Marfan’s syndrome的診斷需有眼睛、骨骼、心臟血管三方面侵犯及家族史四項中二項以上符合即可診斷之。此病例在心臟血管方便有主動瓣閉鎖不全及主動脈剝離的異常，在骨骼方面有體型瘦長、手指及腳趾細長、扁平足及脊柱側彎等異常，符合Marfan氏症候群的診斷。病人並無高血壓病史，引起主動脈剝離的潛在病圖乃Marfan氏症候群。

關鍵字

急性腹症 ； 主動脈剝離 ； Marfan氏症候群

並列摘要

Aortic dissecton is an emergent disease, of which chest pain is the most common presentation. If the dissection involves the abdominal aorta, epigastralgia radiating to the back is the typical presentation. This 28-year-old male is a case of DeBakey type Iaortic dissection presenting with diffuse abdominal pain rather than chest pain or epigastralgia radiating to the back. Physical examination. revealed diffuse abdominal tenderness and rebound pain. Blood pressure was normal. He was slender, tall, with kyphoscoliosis and long fingers (arachnodectyly). Murmur of aortic regurgitation was detected. Laboratory data showed nothing particular except mial anemia and metabolic acidosis serologic test for syphilis was negative. The diagnosis was confirmed to be DeBakey type I aortic dissection by thoraxic and abdominal CT scan, and the dissectioninvolved the orifices of celiac trunk and superior mesenteric artery. When the diagnosis was confirmed, the patient had received aortic reconstruction. Pale looking of intraabdominal organs and aperistalsis of intestines were noted during the operation. After the operation, the symptoms and signs were relieved completely, so the abdominal pain should be due to diffuse ischemia of intra-abdominal organs. Involvement of skeletal, cardiovasularand ocular systems and the positive family history are the 4 criteria for the diagnosis of Marfan’s syndrome. The diagnosis is established, if the patient has 2 or more of the 4 criteria. this patient was diagnosed to have Marfan’s syndrome with cardiovascular and skeletal involvement. In a young person with aortic dissection, Marfan’s syndrome should be considered. Furthermore, aortic dissection with superior mesenteric arterial involvement should be included in the list of differential diagnosis of acute abdomen. Chest pain may be absent or masked in this setting.

並列關鍵字

Acute Abdomen ； Aortic Dissection ； Marfan's Sydrome