ABSTRACT
An 84-year-old man electively underwent abdominal aortic open repair for an abdominal aortic aneurysm. During the operation, the ureter was not confirmed when manipulating the iliac arteries. Subsequently, intestinal paralysis occurred on the fifth day after surgery and a drainage tube of the intestinal tract was inserted. Liquid retention around the left iliopsoas muscle, and left renal nephropathy were recognized on performing enhanced computed tomography (CT) on postoperative day 11. An initial diagnosis of an iliopsoas abscess was considered. Simple CT imaging was performed on the 13th day after surgery without symptomatic improvement. This scan revealed that the contrast agent had remained in the cavity since the previous CT scan, which had been misdiagnosed as an abscess. Ureteral injury was now suspected. Retrograde ureterography revealed an urinoma caused by left ureter injury. We diagnosed paralytic ileus due to urinoma. For drainage of the urine, a percutaneous renal fistula was constructed. He was discharged from the hospital on the 56th postoperative day, and by six months after the operation, the urinary tract problem had disappeared. In conclusion, we report a case of delayed ureteral injury that occurred after abdominal aortic open repair surgery.
ABSTRACT
Acute ischemia due to thromboembolism caused by occluded prosthetic graft after axillary-femoral artery bypass has been reported as axillofemoral bypass graft stump syndrome (AxSS). AxSS usually occurs in the upper extremities and it is rare that it occurs in the lower extremities. We encountered a rare case of a 76-year-old woman with acute right upper and lower extremities ischemia 4 years after right axillary-external iliac artery bypass grafting. The graft and the native arteries of the right upper and lower limbs were occluded. In addition, the right axillary artery and proximal anastomotic site were deformed. We diagnosed acute limb ischemia due to AxSS and immediately performed thrombectomy. Because we considered the thrombosis to originate from the axillary-iliac artery bypass graft, we disconnected the occluded graft from the native arteries. Six months after surgery, she was doing well without recurrence of thromboembolism. We report here the successful treatment of a case of AxSS that developed in both the upper and lower extremities.
ABSTRACT
<p>We herein report on a case in which we conducted bypass surgery for occlusion of a left axillary artery aneurysm with ischemic symptoms 21 years after the contraction of Kawasaki disease and achieved symptomatic improvement. The case involved a 22-year-old man who had been suffering from Kawasaki disease since the age of one. He had been undergoing antiplatelet therapy for bilateral axillary artery aneurysms by orally taking aspirin for 20 years. He suffered from symptoms of upper limb ischemia 21 years after receiving a diagnosis of peripheral aneurysms and occlusion of a left axillary artery aneurysm upon 3DCTA. We conducted aneurysmotomy, plication, and bypass surgery between the axillary and brachial arteries via the autologous vein. Pathological examination revealed due to the formation of atheroma in the tunica intima and disarrangement of the layer structure in the tunica media : thickening of the tunica media was partially observed. His fatigue upon exertion of his left upper extremity remarkably improved following surgery. Although peripheral aneurysms associated with Kawasaki disease are rare, as seen in this case, peripheral arterial disease remains and progresses even after long periods of time. It is believed necessary to carry out long term follow-up and examine the approaches to therapy including surgery in accordance with the site and degree of the disease.</p>