背景:内脏动脉瘤是一种罕见且可能致命的血管疾病,通常影响肠系膜上或肠系膜下动脉,脾,肝,和腹腔动脉,以及他们的树枝。内脏动脉瘤通常可以使用血管内介入治疗,开放手术,或经皮凝血酶注射。
方法:一名9岁的女孩在一场涉及正面碰撞的车祸后,腹部和双侧腿部疼痛被送入我们的创伤中心。
方法:腹部计算机断层扫描(CT)显示肠疝通过左外侧腹壁的肌肉缺损。肝脏和脾脏周围有少量液体,小肠壁轻度增厚,和小肠系膜的浸润,提示小肠损伤的可能性。
方法:紧急剖腹探查术。切除末端回肠和乙状结肠的缺血部位后,肠道连续性重建。对创伤性左外侧腹壁疝进行了一期修复。术后恢复良好,无任何并发症。2个月后随访腹部CT扫描显示肠系膜上动脉回肠分支假性动脉瘤。尽管没有任何胃肠道症状,由于存在延迟破裂或大量出血的显著风险,我们通过使用大量线圈的血管内介入治疗假性动脉瘤.
结果:6个月后随访腹部CT扫描显示假性动脉瘤完全闭塞和吸收。
结论:尽管它在技术上具有挑战性,血管内弹簧圈栓塞术可能是治疗儿童外伤性内脏动脉假性动脉瘤且无并发症的可行技术。
BACKGROUND: Visceral artery aneurysm is a rare and potentially fatal vascular condition that typically affects the superior mesenteric or inferior mesenteric arteries, the splenic, hepatic, and celiac arteries, as well as their branches. Visceral artery aneurysms can usually be treated using endovascular intervention, open surgery, or percutaneous thrombin injection.
METHODS: A 9-year-old girl was admitted to our trauma center with abdominal and bilateral leg pain after a car accident involving a head-on collision.
METHODS: Abdominal computed tomography (CT) showed bowel herniation through a muscle defect in the left lateral abdominal wall. There was a small amount of fluid around the liver and spleen, mild thickening of the small bowel wall, and infiltration in the small bowel mesentery, indicating the possibility of small bowel injury.
METHODS: Emergent exploratory laparotomy was performed. After resection of the ischemic parts of the terminal ileum and sigmoid colon, intestinal continuity was reestablished. Primary repair was performed on a traumatic left lateral abdominal wall hernia. She recovered well postoperatively without any complications. A follow-up abdominal CT scan after 2 months showed a pseudoaneurysm of the ileal branch of the superior mesenteric artery. Despite the absence of any gastrointestinal symptoms, the pseudoaneurysm was treated by endovascular intervention using numerous coils because of the significant risk of delayed rupture or massive bleeding.
RESULTS: Follow-up abdominal CT scan after 6 months showed complete occlusion and resorption of the pseudoaneurysm.
CONCLUSIONS: Although it is technically challenging, endovascular coil embolization may be a feasible technique in children with traumatic visceral artery pseudoaneurysms without complications.