Successful Treatment for a Ruptured Solitary Tuberculous Aneurysm of the Left External Iliac Artery: A Case Report
We report an extremely rare case of ruptured tuberculous external iliac artery aneurysm. A 75-year-old woman was admitted to another hospital 8 months ago for pleural inflammation and was treated with antibiotics. Mycobacterium tuberculosis was detected in the pleural fluid submitted at that time. S...
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| Published in | Japanese Journal of Vascular Surgery Vol. 32; no. 4; pp. 257 - 260 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
JAPANESE SOCIETY FOR VASCULAR SURGERY
02.07.2023
特定非営利活動法人 日本血管外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0918-6778 1881-767X |
| DOI | 10.11401/jsvs.23-00026 |
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| Abstract | We report an extremely rare case of ruptured tuberculous external iliac artery aneurysm. A 75-year-old woman was admitted to another hospital 8 months ago for pleural inflammation and was treated with antibiotics. Mycobacterium tuberculosis was detected in the pleural fluid submitted at that time. She had been suspected of having an iliopsoas abscess by her local doctor due to left lower abdominal pain and fever for 2 weeks, and was treated with antibiotics, but the symptoms did not improve. A contrast-enhanced CT scan was performed, and a diagnosis of ruptured infected left external iliac artery aneurysm was made. Emergency laparotomy was performed, and the patient underwent aneurysmectomy, drainage, and extra-anatomical bypass with rifampicin-immersed Dacron graft. Tubercle bacilli were detected locally, and histopathological examination revealed specific tuberculous lesions on the aneurysmal wall, leading to the diagnosis of tuberculous aneurysm. The patient was discharged from the hospital on the 68th postoperative day after with anti-tuberculosis drugs. The patient continued chemotherapy for one year after surgery, and no recurrence has occurred for more than five years after an end of chemotherapy. |
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| AbstractList | We report an extremely rare case of ruptured tuberculous external iliac artery aneurysm. A 75-year-old woman was admitted to another hospital 8 months ago for pleural inflammation and was treated with antibiotics. Mycobacterium tuberculosis was detected in the pleural fluid submitted at that time. She had been suspected of having an iliopsoas abscess by her local doctor due to left lower abdominal pain and fever for 2 weeks, and was treated with antibiotics, but the symptoms did not improve. A contrast-enhanced CT scan was performed, and a diagnosis of ruptured infected left external iliac artery aneurysm was made. Emergency laparotomy was performed, and the patient underwent aneurysmectomy, drainage, and extra-anatomical bypass with rifampicin-immersed Dacron graft. Tubercle bacilli were detected locally, and histopathological examination revealed specific tuberculous lesions on the aneurysmal wall, leading to the diagnosis of tuberculous aneurysm. The patient was discharged from the hospital on the 68th postoperative day after with anti-tuberculosis drugs. The patient continued chemotherapy for one year after surgery, and no recurrence has occurred for more than five years after an end of chemotherapy. We report an extremely rare case of ruptured tuberculous external iliac artery aneurysm. A 75-year-old woman was admitted to another hospital 8 months ago for pleural inflammation and was treated with antibiotics. Mycobacterium tuberculosis was detected in the pleural fluid submitted at that time. She had been suspected of having an iliopsoas abscess by her local doctor due to left lower abdominal pain and fever for 2 weeks, and was treated with antibiotics, but the symptoms did not improve. A contrast-enhanced CT scan was performed, and a diagnosis of ruptured infected left external iliac artery aneurysm was made. Emergency laparotomy was performed, and the patient underwent aneurysmectomy, drainage, and extra-anatomical bypass with rifampicin-immersed Dacron graft. Tubercle bacilli were detected locally, and histopathological examination revealed specific tuberculous lesions on the aneurysmal wall, leading to the diagnosis of tuberculous aneurysm. The patient was discharged from the hospital on the 68th postoperative day after with anti-tuberculosis drugs. The patient continued chemotherapy for one year after surgery, and no recurrence has occurred for more than five years after an end of chemotherapy. 極めて稀な結核性外腸骨動脈瘤破裂の1手術例を経験したので報告する．症例は75歳，女性，8カ月前に胸膜炎のため他院での入院治療を受け抗生剤投与により軽快した．その際に提出されていた胸水より結核菌が検出されていた．今回2週間前より左下腹部痛と発熱のため近医にて腸腰筋膿瘍を疑われ抗生剤治療が行われるが改善せず，単純CT検査および腰部MRIが施行され動脈瘤破裂の可能性があり当院へ転送となった．造影CT検査を施行し感染性左外腸骨動脈瘤破裂と診断した．緊急開腹手術を行い，瘤切除と洗浄ドレナージおよびリファンピシン浸漬人工血管による非解剖学的バイパス術を施行した．局所より結核菌を検出し病理組織学的検査でも瘤壁に特異的な結核病変を認めたことから結核性動脈瘤と診断した．術後には抗結核薬による化学療法を行い術後68日目に軽快退院した．術後1年間化学療法を継続し中止後も5年以上を経過して再発は起こっていない． |
| Author | Kawahito, Tomohisa Yoshida, Homare Shimoe, Yasushi Okuda, Naoki Hosoya, Yuta |
| Author_FL | 下江 安司 細谷 祐太 吉田 誉 川人 智久 奥田 直樹 |
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| Author_xml | – sequence: 1 fullname: Okuda, Naoki organization: Department of Cardiovascular Surgery, National Hospital Organization Shikoku Medical Center for Children and Adults – sequence: 1 fullname: Hosoya, Yuta organization: Department of Cardiovascular Surgery, National Hospital Organization Shikoku Medical Center for Children and Adults – sequence: 1 fullname: Shimoe, Yasushi organization: Department of Cardiovascular Surgery, National Hospital Organization Shikoku Medical Center for Children and Adults – sequence: 1 fullname: Kawahito, Tomohisa organization: Department of Cardiovascular Surgery, National Hospital Organization Shikoku Medical Center for Children and Adults – sequence: 1 fullname: Yoshida, Homare organization: Department of Cardiovascular Surgery, National Hospital Organization Shikoku Medical Center for Children and Adults |
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| References | 6) Yamashiro S, Arakaki R, Kise Y, et al. Potential role of omental wrapping to prevent infection after treatment for infectious thoracic aortic aneurysms. Eur J Cardiothorac Surg 2013; 43: 1177–1182. 12) World Health Organization. Treatment of tuberculosis guidelines. Geneva: World Health Organization; 2010. p. 29–31. 9) Uchida N, Katayama A, Tamura K, et al. In situ replacement for mycotic aneurysms on the thoracic and abdominal aorta using rifampicin-bonded grafting and omental pedicle grafting. Ann Thorac Surg 2012; 93: 438–442. 10) Ikeda S, Shih M, Likourezos A, et al. The treatment of tuberculous aortic pseudoaneurysm. J Card Surg 2018; 33: 840–852. 7) Ikezawa T, Iwatsuka Y, Naiki K, et al. Tuberculous pseudaneurysm of the descending thoracic aorta: a case report and literature review of surgically treated cases. J Vasc Surg 1996; 24: 693–697. 8) Labrousse L, Montaudon M, Le Guyader A, et al. Endovascular treatment of a tuberculous infected aneurysm of the descending thoracic aorta: a word of caution. J Vasc Surg 2007; 46: 786–788. 3) Volini FI, Olfield RC, Thompson JR, et al. Tuberculosis of the aorta. JAMA 1962; 181: 78–83. 4) 佐藤友昭，日置厳雄，森本 保，他．食道穿破した結核性胸腹部仮性大動脈瘤に対しステントグラフト内挿術を施行した1例．胸部外科2015; 68: 141–144. 11) 松竹豊司，橋詰浩二，木下直江，他．粟粒結核に伴った結核性腹部大動脈瘤の1例．結核2015; 90: 463–468. 1) 根本 卓，保坂晃弘．結核性胸部大動脈瘤に対しステントグラフト内挿術を施行した1例．日血外会誌2019; 28: 331–334. 5) 佐伯宗弘，柚木継二，迫田直也，他．BCG膀胱内注入療法後に発生した結核性感染性胸部大動脈瘤に対するTEVARの1例．日心外会誌2017; 46: 45–48. 2) 諸星保憲．結核性大腿動脈瘤の1例．日血外会誌2001; 10: 679–682. |
| References_xml | – reference: 6) Yamashiro S, Arakaki R, Kise Y, et al. Potential role of omental wrapping to prevent infection after treatment for infectious thoracic aortic aneurysms. Eur J Cardiothorac Surg 2013; 43: 1177–1182. – reference: 11) 松竹豊司，橋詰浩二，木下直江，他．粟粒結核に伴った結核性腹部大動脈瘤の1例．結核2015; 90: 463–468. – reference: 3) Volini FI, Olfield RC, Thompson JR, et al. Tuberculosis of the aorta. JAMA 1962; 181: 78–83. – reference: 7) Ikezawa T, Iwatsuka Y, Naiki K, et al. Tuberculous pseudaneurysm of the descending thoracic aorta: a case report and literature review of surgically treated cases. J Vasc Surg 1996; 24: 693–697. – reference: 1) 根本 卓，保坂晃弘．結核性胸部大動脈瘤に対しステントグラフト内挿術を施行した1例．日血外会誌2019; 28: 331–334. – reference: 4) 佐藤友昭，日置厳雄，森本 保，他．食道穿破した結核性胸腹部仮性大動脈瘤に対しステントグラフト内挿術を施行した1例．胸部外科2015; 68: 141–144. – reference: 8) Labrousse L, Montaudon M, Le Guyader A, et al. Endovascular treatment of a tuberculous infected aneurysm of the descending thoracic aorta: a word of caution. J Vasc Surg 2007; 46: 786–788. – reference: 10) Ikeda S, Shih M, Likourezos A, et al. The treatment of tuberculous aortic pseudoaneurysm. J Card Surg 2018; 33: 840–852. – reference: 2) 諸星保憲．結核性大腿動脈瘤の1例．日血外会誌2001; 10: 679–682. – reference: 12) World Health Organization. Treatment of tuberculosis guidelines. Geneva: World Health Organization; 2010. p. 29–31. – reference: 5) 佐伯宗弘，柚木継二，迫田直也，他．BCG膀胱内注入療法後に発生した結核性感染性胸部大動脈瘤に対するTEVARの1例．日心外会誌2017; 46: 45–48. – reference: 9) Uchida N, Katayama A, Tamura K, et al. In situ replacement for mycotic aneurysms on the thoracic and abdominal aorta using rifampicin-bonded grafting and omental pedicle grafting. Ann Thorac Surg 2012; 93: 438–442. |
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| SubjectTerms | external iliac artery aneurysm extra-anatomical revascularization ruptured aneurysm tuberculous aneurysm 動脈瘤破裂 外腸骨動脈瘤 結核性動脈瘤 非解剖学的血行再建 |
| Title | Successful Treatment for a Ruptured Solitary Tuberculous Aneurysm of the Left External Iliac Artery: A Case Report |
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