一過性脊髄虚血症状で発見された腹部大動脈瘤の1例
症例は64歳男性．起床後に両下肢が動かないことに気づき救急要請．来院時両下肢の脱力，腹痛，腰痛を認めた．CT検査・腹部血管超音波検査にて最大径65×62 mmの腹部大動脈瘤を認めた．後壁側に血栓を認め，血栓内にCT画像ではhigh density area，腹部血管超音波検査では無エコー域を認め，壁在血栓の一部が液状化していると考えられた．来院後，脊髄虚血症状は徐々に改善傾向となったが，翌日下血を認め，緊急大腸内視鏡検査にて直腸の虚血性大腸炎と診断された．腹部大動脈瘤内の壁在血栓が腰動脈や内腸骨動脈に飛散し脊髄虚血や虚血性大腸炎を発症したと考えられた．脊髄虚血症状や直腸病変等を厳重に経過観察し...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 53; no. 1; pp. 38 - 42 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本心臓血管外科学会
15.01.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.53.38 |
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| Abstract | 症例は64歳男性．起床後に両下肢が動かないことに気づき救急要請．来院時両下肢の脱力，腹痛，腰痛を認めた．CT検査・腹部血管超音波検査にて最大径65×62 mmの腹部大動脈瘤を認めた．後壁側に血栓を認め，血栓内にCT画像ではhigh density area，腹部血管超音波検査では無エコー域を認め，壁在血栓の一部が液状化していると考えられた．来院後，脊髄虚血症状は徐々に改善傾向となったが，翌日下血を認め，緊急大腸内視鏡検査にて直腸の虚血性大腸炎と診断された．腹部大動脈瘤内の壁在血栓が腰動脈や内腸骨動脈に飛散し脊髄虚血や虚血性大腸炎を発症したと考えられた．脊髄虚血症状や直腸病変等を厳重に経過観察し改善傾向となったため，2週間後に開腹での人工血管置換術を施行した．術後も脊髄虚血症状や虚血性大腸炎は悪化することなく，速やかに改善し，術後13日目に退院した．一過性脊髄虚血症状から発見された腹部大動脈瘤症例はきわめて稀と考えられ報告する． |
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| AbstractList | 症例は64歳男性．起床後に両下肢が動かないことに気づき救急要請．来院時両下肢の脱力，腹痛，腰痛を認めた．CT検査・腹部血管超音波検査にて最大径65×62 mmの腹部大動脈瘤を認めた．後壁側に血栓を認め，血栓内にCT画像ではhigh density area，腹部血管超音波検査では無エコー域を認め，壁在血栓の一部が液状化していると考えられた．来院後，脊髄虚血症状は徐々に改善傾向となったが，翌日下血を認め，緊急大腸内視鏡検査にて直腸の虚血性大腸炎と診断された．腹部大動脈瘤内の壁在血栓が腰動脈や内腸骨動脈に飛散し脊髄虚血や虚血性大腸炎を発症したと考えられた．脊髄虚血症状や直腸病変等を厳重に経過観察し改善傾向となったため，2週間後に開腹での人工血管置換術を施行した．術後も脊髄虚血症状や虚血性大腸炎は悪化することなく，速やかに改善し，術後13日目に退院した．一過性脊髄虚血症状から発見された腹部大動脈瘤症例はきわめて稀と考えられ報告する． |
| Author | 三好, 麻衣子 大谷, 享史 |
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| References | 11) Peppelenbosch AG, Windsant V, Jacobs MJ et al. Open repair for ruptured abdominal aortic aneurysm and the risk of spinal cord ischemia: review of the literature and risk-factor analysis. Eur J Vasc Endovasc Surg 2010; 40: 589-95. 8) Ki YJ, Jeon BH, Bang HJ et al. Spinal code infarction caused by non-dissected and unruptured thoracoabdominal aortic aneurysm with infraluminal thrombus. Ann Rehabil Med 2012; 36: 297-302. 3) Murakami T, Koyanagi I. An algorithm for the diagnosis of spine and spinal cord disorder due to vascular lesion. Spine Spinal Cord 2010; 23: 943-51. 7) Vargas MI, Gariani R, Sztajzel I et al. Spinal code ischemia: practical imaging tis, pearls, and pitfalls. AJNR Am J Neuroradiol 2015; 36: 825-30. 4) Millichap JJ, Bernard T, Leacock RO. Spinal code infarction with multiple etiologic factors. J Gen Intern Med 2007; 22: 151-4. 2) Tokuhashi Y, Kamii H, Oshima M. An algorithm for the diagnosis of compression myelopathy. Spine Spinal Cord 2010; 23: 933-42. 15) Behrendt CA, Henrik C, Schwaneberg T et al. Incidence, predictors, and outcomes of colonic ischemia in abdominal aortic aneurysm repair. Eur Endovasc Surg 2018; 56: 507-13. 16) Perry RJ, Martin MJ, Eckert MJ et al. Colonic ischemia complicating open vs endovascular abdominal aortic aneurysm repair. J Vasc Surg 2008; 48: 272-7. 10) Ikkoh I, Aoki C, Tamo W et al. Anterior spinal artery syndrome due to temporary ischemia following aneurysmectomy of a ruptured abdominal aortic aneurysm. Jpn J Vasc Surg 2003; 12: 39-42. 12) Bogie R, Willigendael EM, Booij M et al. Acute thrombosis of an abdominal aortic aneurysm: a case report. Eur J Vasc Endovasc Surg 2008; 35: 590-2. 13) Watson TJ, Childers WK, Haga L et al. Acute bilateral lower extremity paralysis secondary to acute thrombosis of an infrarenal abdominal aortic aneurysm. Aorta 2017; 5: 91-5. 5) El-Osta B, Ghoz A, Singh VK et al. Spontaneous spinal cord infarction secondary to embolism from an aortic aneurysm mimicking as cauda equine due to disc prolapse: a case report. Cases J 2009; 2: 1-4. 9) Morisaki K, Matsumoto T, Matsubara Y et al. A rare complication of spinal cord ischemia following endovascular aneurysm repair of an infrarenal abdominal aortic aneurysm with arteriosclerosis obliterans: report of a case. Ann Vasc Dis 2016; 9: 255-7. 6) Ates I, Kaplan M, Ozqalik M et al. Transient ischemic attack of spinal cord due to abdominal aortic aneurysm thrombus. Ann Vasc Surg 2016; 30: 307e7-9. 14) Koshina T, Murakami G, Morishita K et al. Does the Adamkiewicz artery originate from the larger segmental arteries ?. J Thorac Cardiovasc Surg 1999; 177: 898-905. 17) Moghadamyeghaneh Z, Michael DS, Samuel LC et al. Risk factors and outcome of postoperative ischemic colitis in contemporary open and endovascular abdominal aortic aneurysm repair. J Vasc Surg 2016; 63: 866-72. 1) Aoyama T, Hida K. An algorithm for the diagnosis of spine and spinal cord tumors. Spine Spinal Cord 2010; 23: 921-31. |
| References_xml | – reference: 17) Moghadamyeghaneh Z, Michael DS, Samuel LC et al. Risk factors and outcome of postoperative ischemic colitis in contemporary open and endovascular abdominal aortic aneurysm repair. J Vasc Surg 2016; 63: 866-72. – reference: 2) Tokuhashi Y, Kamii H, Oshima M. An algorithm for the diagnosis of compression myelopathy. Spine Spinal Cord 2010; 23: 933-42. – reference: 11) Peppelenbosch AG, Windsant V, Jacobs MJ et al. Open repair for ruptured abdominal aortic aneurysm and the risk of spinal cord ischemia: review of the literature and risk-factor analysis. Eur J Vasc Endovasc Surg 2010; 40: 589-95. – reference: 6) Ates I, Kaplan M, Ozqalik M et al. Transient ischemic attack of spinal cord due to abdominal aortic aneurysm thrombus. Ann Vasc Surg 2016; 30: 307e7-9. – reference: 4) Millichap JJ, Bernard T, Leacock RO. Spinal code infarction with multiple etiologic factors. J Gen Intern Med 2007; 22: 151-4. – reference: 12) Bogie R, Willigendael EM, Booij M et al. Acute thrombosis of an abdominal aortic aneurysm: a case report. Eur J Vasc Endovasc Surg 2008; 35: 590-2. – reference: 3) Murakami T, Koyanagi I. An algorithm for the diagnosis of spine and spinal cord disorder due to vascular lesion. Spine Spinal Cord 2010; 23: 943-51. – reference: 8) Ki YJ, Jeon BH, Bang HJ et al. Spinal code infarction caused by non-dissected and unruptured thoracoabdominal aortic aneurysm with infraluminal thrombus. Ann Rehabil Med 2012; 36: 297-302. – reference: 14) Koshina T, Murakami G, Morishita K et al. Does the Adamkiewicz artery originate from the larger segmental arteries ?. J Thorac Cardiovasc Surg 1999; 177: 898-905. – reference: 9) Morisaki K, Matsumoto T, Matsubara Y et al. A rare complication of spinal cord ischemia following endovascular aneurysm repair of an infrarenal abdominal aortic aneurysm with arteriosclerosis obliterans: report of a case. Ann Vasc Dis 2016; 9: 255-7. – reference: 5) El-Osta B, Ghoz A, Singh VK et al. Spontaneous spinal cord infarction secondary to embolism from an aortic aneurysm mimicking as cauda equine due to disc prolapse: a case report. Cases J 2009; 2: 1-4. – reference: 15) Behrendt CA, Henrik C, Schwaneberg T et al. Incidence, predictors, and outcomes of colonic ischemia in abdominal aortic aneurysm repair. Eur Endovasc Surg 2018; 56: 507-13. – reference: 13) Watson TJ, Childers WK, Haga L et al. Acute bilateral lower extremity paralysis secondary to acute thrombosis of an infrarenal abdominal aortic aneurysm. Aorta 2017; 5: 91-5. – reference: 1) Aoyama T, Hida K. An algorithm for the diagnosis of spine and spinal cord tumors. Spine Spinal Cord 2010; 23: 921-31. – reference: 7) Vargas MI, Gariani R, Sztajzel I et al. Spinal code ischemia: practical imaging tis, pearls, and pitfalls. AJNR Am J Neuroradiol 2015; 36: 825-30. – reference: 16) Perry RJ, Martin MJ, Eckert MJ et al. Colonic ischemia complicating open vs endovascular abdominal aortic aneurysm repair. J Vasc Surg 2008; 48: 272-7. – reference: 10) Ikkoh I, Aoki C, Tamo W et al. Anterior spinal artery syndrome due to temporary ischemia following aneurysmectomy of a ruptured abdominal aortic aneurysm. Jpn J Vasc Surg 2003; 12: 39-42. |
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| SubjectTerms | 一過性脊髄虚血 腹部大動脈瘤 虚血性大腸炎 |
| Title | 一過性脊髄虚血症状で発見された腹部大動脈瘤の1例 |
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