脾动脉假性动脉瘤破裂致上消化道大出血1例  

Massive upper gastrointestinal bleeding caused by splenic artery pseudoaneurysm rupture:A case report

作　　者：周密 何蕾 陈娅琦 曾亚 申月明 Mi Zhou;Lei He;Ya-Qi Chen;Ya Zeng;Yue-Ming Shen(Graduate School,Hunan University of Chinese Medicine,Changsha 410208,Hunan Province,China;Changsha Central Hospital Affiliated to University of South China,Changsha 410208,Hunan Province,China)

机构地区：[1]湖南中医药大学研究生院,湖南省长沙市410208 [2]南华大学附属长沙中心医院消化内科,湖南省长沙市410208

出　　处：《世界华人消化杂志》2022年第23期1046-1050,共5页World Chinese Journal of Digestology

摘　　要：背景脾动脉假性动脉瘤(splenic artery pse-udoaneurysm,SAP)破裂导致上消化道出血是一种罕见但危及生命的情况.由于发病率低,其诊断及治疗仍然是一个挑战.当患者以上消化道出血入院时,极易忽视SAP破裂这一病因.病历简介本文报道了一例65岁男性因呕血入院.经内镜检查和影像学检查,他被诊断为SAP破裂导致上消化道出血.他接受了手术治疗,并于术后20 d出院.目前,患者生活质量良好,无呕血及黑便.结论在本病例中,发现了一例未知病因的SAP,其破裂致胃瘘,最终导致上消化道大出血,通过及时诊治,挽救了患者的生命.因此即使患者既往无胰腺疾病、创伤史等,我们仍然建议,急性上消化道出血患者应考虑SAP的鉴别诊断.同时,一旦发现SAP,应采取及时诊断和紧急治疗策略,以取得良好效果.BACKGROUND Upper gastrointestinal(UGI)bleeding secondary to a ruptured splenic artery pseudoaneurysm(SAP)is a rare but life-threatening condition.Owing to the low prevalence,it remains a diagnostic and therapeutic challenge.When patients are admitted to the hospital with UGI bleeding,it is easy to overlook the cause of SAP rupture.CASE SUMMARY We report the case of a 65-year-old man who was admitted to our hospital with hematemesis.By endoscopic inspection and imaging examination,he was diagnosed with a ruptured SAP that caused UGI bleeding.He underwent surgery and was discharged 20 d after surgery.Now,he has good quality of life,with no incidents of hematemesis or melena.CONCLUSION We have documented a case of SAP rupture of unknown etiology,in which the ruptured SAP caused a gastric fistula that eventually resulted in massive UGI bleeding.Through timely diagnosis and treatment,the patient’s life was saved.Therefore,even if patients with acute UGI bleeding have no previous history of pancreatic disease,abdominal trauma,etc.,it is still suggested that SAP be considered as a differential diagnosis.Once SAP is found,a prompt diagnosis and urgent treatment strategy should be employed to achieve good results.

关 键 词：脾动脉假性动脉瘤 上消化道出血 病例报道 

分 类 号：R573.2[医药卫生—消化系统]