松浦 馨

OBJECTIVE: We report a rare complication--stenosis of the proximal anastomotic site caused by an inside felt strip--in surgery for acute type A aortic dissection. METHODS: Eight weeks after the emergent repair, the patient suffered from anemia and persistent high-grade fever. Computed tomography and transesophageal echocardiography revealed considerable aortic stenosis, while laboratory data showed hemolytic anemia associated with some inflammatory changes. RESULTS: After surgical relief of the aortic stenosis, inflammatory change improved and anemia also disappeared. CONCLUSION: It is evident that the inner felt strip used for reinforcement of the proximal anastomosis can cause remarkable stenosis, resulting in hemolytic anemia and inflammatory changes.

We report a very rare case of spontaneous ilioappendicial fistula with right common iliac aneurysm. After the aneurysm was opened, afferent and efferent vessels were closed following extraanatomical femorofemoral bypass, and the appendectomy was performed. The wall of the aneurysm showed the atherosclerotic change and histologic study of the appendix confirmed the diagnosis of acute appendicitis. Enhanced computed tomography was useful for the diagnosis and the extraanatomical bypass was deemed the most effective operative strategy. The pathogenesis of the fistula was surmised to be related to the appendicitis.