妊娠に合併した腎動脈瘤破裂の1例

Abstract

32歳女.左側腹部痛を主訴とし, 母体血圧低下, 胎児心拍低下を認めた.そのため帝王切開を施行し, 後腹膜に血腫が認められたが経過観察として閉腹した.腹部CTにて左腎動脈付近の出血および横隔膜直下より骨盤腟に至る後腹膜全体に広がる血腫を認めた.左腎動脈付近い動脈瘤が認められ, 左腎摘出術を施行した.腎動脈分岐付近に動脈瘤および下方に壁欠損が認められた.fibromuscular dysplasiaと診断された.動脈硬化や膠原病などを示す異常所見は認められず, 動脈瘤は先天的なものであると考えられた

We report a case of renal artery aneurysm ruptured during pregnancy. A 32-year-old woman presented at 38th week of gestation with left flank pain. We performed a cesarean delivery for fetal distress, and found retroperitoneal hemorrhage. After delivery, she entered a pre-shock state, and abdominal computed tomography and angiography showed a left renal artery aneurysm and hemorrhage from the aneurysm. Left nephrectomy was performed, and both mother and baby were rescued. Renal artery rupture during pregnancy is a fatal event, but with quick diagnosis and adequate treatment, if possible nephron sparing surgery, most patients, including babies, can be rescued.