摘要
目的探讨自发性脾动脉瘤(splenic artery aneurysm,SAA)破裂的临床特点、诊疗方法及误诊原因。方法对我院收治的自发性SAA破裂两例误诊资料进行回顾性分析,并复习相关文献。结果 1例老年男性,7 d前出现短暂的上腹部剧痛,后自行缓解,当地医院考虑为胃肠道疾病,胃镜检查后突发意识不清,以腹腔内出血和失血性休克急诊入院,行腹腔穿刺抽出血性液体,腹部增强CT检查示SAA破裂,给予介入脾动脉栓塞术治愈。1例中年男性,表现为上腹部剧痛,初误诊为急性胰腺炎、感染性休克,液体复苏后,床旁超声和腹部CT检查示腹腔内出血,急行剖腹探查,术中证实为SAA破裂引起腹腔大出血,给予脾动脉近端结扎、动脉瘤及脾切除术,治愈。结论 SAA发病率低,一旦破裂可引起腹腔内出血而危及患者生命。对于不明原因腹腔内出血和失血性休克的鉴别诊断应考虑到SAA破裂可能,早期诊断和治疗对提高患者生存率至关重要。
Objective To investigate the clinical features and emergency diagnosis and treatment of splenic artery aneurysm（ SAA） rupture. Methods Clinical data of two cases of SAA ruptures were retrospectively analyzed. We also reviewed pertinent literature. Results A senior male patient complained of transient and severe epigastric pain for 7 days and was initially diagnosed with stomach illness in a local hospital. The symptom disappeared without any treatment. The patient suffered abrupt onset of unconsciousness combined with peritoneal hemorrhage and hemorrhagic shock after gastroscopy. Paracentesis revealed bloody fluid. According to the abdominal computed tomographic,the case was diagnosed as rupture of splenic artery aneurysm. The patient was given interventional embolization of the splenic artery; the other case was a middle-aged male,admitted to a local hospital for severe abdominal pain. The patient was initially misdiagnosed with acute pancreatitis,and septic shock. After fluid resuscitation,emergency bedside ultrasound and abdominal CT scan revealed diffuse hemoperitoneum without a clear source. After fluid resuscitation,laparotomy revealed excessive intraperitoneal hemorrhage due to a ruptured SAA. The patient underwent a ligation of the proximal portion of the artery together with resection of the aneurysm and spleen and the he was cured. Conclusion Splenic artery aneurysm（ SAA） is a rare disease and potentially life-threatening clinical entity that carries a risk of rupture and peritoneal hemorrhage. Splenic artery aneurysm ruptures should be considered in the differential diagnosis in any patient with undifferentiated hemoperitoneum and shock. Early diagnosis and treatment are crucial for the patient＇s survival.
出处
《临床误诊误治》
2015年第10期52-55,共4页
Clinical Misdiagnosis & Mistherapy
关键词
动脉瘤
破裂
误诊
胃病
肠疾病
胰腺炎
休克
Aneurysm
ruptured
Misdiagnosis
Stomach disease
Intestinal disease
Pancreatitis
Shock
