误诊为十二指肠肿瘤的腹主动脉瘤破裂引起胃肠道出血1例

Gastrointestinal hemorrhage caused by abdominal aortic aneurysm rupture misdiagnosed as duodenal tumor:a report of one case

上消化道大出血常危急患者生命,虽然临床诊断容易,但出血后立即明确病因较困难,本例患者反复多次出现大量呕血、便血后,并伴有失血性休克,对生命造成极大的威胁,经多次抢救、对症治疗,急诊胃镜及上腹部CT疑诊十二指肠肿瘤,后于外科手术中拟行胰十二指肠病灶切除时出现动脉喷射性出血,术中诊断为腹主动脉瘤破裂入十二指肠,行腹主动脉破裂修补术,二期行腹主动脉支架后患者痊愈,临床上应重视胃肠道出血少见原因,及时正确选择合适的辅助检查,明确出血病因,对治疗、挽救患者生命具有极其重要意义.

Upper gastrointestinal hemorrhage is often life-threatening.Although its clinical diagnosis is easy,it is usually difficult to find out the exact cause.The patient in this case had repeated hematemesis,melena and hemorrhagic shock,which caused great threat to life.Repeated rescues and symptomatic treatments were given.Duodenal tumor was suspected after emergency endoscopy and upper abdominal CT.During the surgery scheduled for the resection of pancreatic-duodenal lesions,arterial spurting occurred.Thus,abdominal aortic aneurysm rupture was diagnosed intraoperatively and then repaired.After inserting an aortic stent,the patient recovered.For patients with gastrointestinal hemorrhage,it is of vital importance to pay attention to uncommon causes of gastrointestinal hemorrhage and to conduct appropriate examinations.A clear diagnosis is very important for treatment.