Michał Szpinda, Piotr Flisiński, Stanisław Molski
CaseRepClinPractRev 2001; 2(2):112-115
'Chronic-contained' rupture of abdominal aortal aneurysm should be taken into account in elderly patients with pains in the lumbosacral region and spondylosis. The diagnosis is suggested by a characteristic triad of symptoms: 1. Abdominal or sacral pain, 2. Shock and 3. Presence of pulsating resistance in the abdomen. Such diagnosis is established in patients with chronic pain (of several week or month duration). This paper documents two cases of 'chronic-contained' abdominal aorta and right common iliac artery aneurysms. In case 1, retroperitoneal rupture of abdominal aortal aneurysm with large retroperitoneal hematoma and complete damage of lumbar vertebral bodies was diagnosed intraoperatively. A bifurcated aorto-iliac stent was implanted below the renal artery into the bifurcations of common iliac arteries. Subcutaneous eventration was sutured on the eighth day following the reconstructive surgery of the arteries. In case 2, a giant ruptured aneurysm of the right common iliac artery with a massive hematoma compressing the right common iliac vein was diagnosed intraoperatively. Vascular reconstruction involved implantation of a PTFE vascular prosthesis from the proximal segment of the right common iliac artery to the femoral artery branching out to the internal iliac artery. No postoperative complications were observed. After the diagnosis of 'chronic-contained' rupture of the abdominal aorta or iliac artery aneurysm, the patient should be subjected to emergency surgery in order to prevent shock.
Keywords: ‘chronic-contained’ rupture, aneurysms