第2巻 2006年10月　第4号

■症例報告

著明な腹痛から腹部大動脈瘤破裂が疑われた炎症性腹部大動脈瘤の1治験例
岩城　秀行¹, 倉岡　節夫¹, 建部　祥¹, 落　雅美², 清水　一雄^2
1水戸済生会総合病院心臓血管外科
²日本医科大学大学院医学研究科機能制御再生外科学

A Successful Surgical Case: Inflammatory Abdominal Aortic Aneurysm with Distinct Abdominal Pain, Is It Really an Aortic Rupture?
Hideyuki Iwaki¹, Setsuo Kuraoka¹, Shou Tatebe¹, Masami Ochi² and Kazuo Shimizu^2
1Department of Cardiovascular Surgery, Mito Saiseikai General Hospital, Mito
²Department of Biological Reguldtion and Regenerative Surgery, Nippon Medical School Graduate School of Medicine

A 75-year-old woman was admitted to our hospital with a chief complaint of distinct abdominal pain. At first we suspected rupture of an abdominal aortic aneurysm because of the presence of a pulsatile abdominal mass. However, the computed tomography with contrast enhancement revealed an infrarenal abdominal aortic aneurysm with marked thickening of the aneurysmal wall (mantle core sign) and left hydronephrosis. Left hydronephrosis was caused by rigid adherence of the adjacent left ureter to the aneurysmal wall. We diagnosed an unruptured inflammatory abdominal aortic aneurysm and performed elective surgical replacement of the abdominal aorta using a Y-shaped woven Dacron graft. We avoided urological intervention for the hydronephrosis to prevent injury to the ureter because marked thickening of the aneurysmal wall and rigid adherence of adjacent structures decrease after surgery. Recognition of abdominal aortic aneurysm with careful diagnostic management before surgery can help determine the operative strategy.

日医大医会誌 2006; 2(4), 206-209

Key words
inflammatory abdominal aortic aneurysm, hydronephrosis

Correspondence to
Hideyuki Iwaki, Department of Cardiovascular Surgery, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamakari, Inba-mura, Inba-gun, Chiba 270-1694, Japan
E-mail：iwaki@nms.ac.jp

受付：2006年4月24日　受理：2006年5月16日