A Case of Chronic Contained Rupture of an Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A 72-year-old man was referred to our hospital because of lumbago and an abdominal aortic aneurysm (AAA). Computed tomography revealed the AAA to be 5cm in diameter with a retroperitoneal hematoma. A diagnosis of chronic contained rupture of an AAA was made, and an operation was performed. At laparotomy, a punched-out defect (10×20mm) that was thought to connect the thrombosed aneurysm to an organized retroperitoneal hematoma was discovered on the right side of the aorta. The aneurysm was replaced with a Y-shaped prosthetic graft. The patient's postoperative course was uneventful. This case of chronic contained rupture of an AAA was distinctly different from cases of acute rupture. Although patients with chronic contained rupture of an AAA are hemodynamically stable, such cases should be assessed and treated as quickly as possible because of the risk of re-rupture.

A Case of Chronic Contained Rupture of Abdominal Aortic Aneurysm Resulting from Spinal Caries / 日本心臓血管外科学会雑誌

We report a case of a chronic contained rupture of abdominal aortic aneurysm associated with spinal caries. A giant retroperitoneal mass with bony destruction of the anterior bodies of thoracic and lumber vertebrae was detected on computed tomography in a 72-year-old woman. The patient was asymptomatic but had a history of spinal tuberculosis complicated with cold abcess 44 years earlier. Magnetic resonance imaging suggested the presence of a paravertebral retroperitoneal abscess or organized hematoma. Surgery was performed through median laparotomy and an aortotomy revealed a punched-out defect, 17mm×17mm in size, in the posterior wall of the abdominal aorta, and the large cavity of an aneurysm with an organized thrombus was observed through the defect. The abdominal aorta and common iliac arteries were replaced with a bifurcated graft. The punched-out defect was closed with the anterior wall of the aorta for the purpose of isolating the prosthesis from the aneurysm. The postoperative course was uneventful and there were no signs of prolonged inflammatory reactions. In this case, it was considered that chronic contained rupture of the abdominal aortic aneurysm resulted from spinal tuberculous osteomyelitis eroding into the aorta.

A Case of Chronic Contained Rupture of a Common Iliac Artery Aneurysm Induced by Trauma / 日本心臓血管外科学会雑誌

We experienced a surgically treated case of chronic contained rupture of a common iliac artery aneurysm. A large number of cases of chronic contained ruptures of the abdominal aorta have been reported; however, that of the common iliac artery is very rare. A 66-year-old man was injured in a bicycle accident. Three months later, the patient felt a dull abdominal pain and noticed a tumor in the left lower abdomen. On presenting computed tomography (CT) scan revealed an aneurysm of the left common iliac artery. After further examinations, a contained rupture of the left common iliac artery aneurysm was diagnosed. At operation, the main aneurysm, 7.5×6.5cm in size, was seen in the left common iliac artery, extending to the right common iliac artery and the infrarenal abdominal aorta. A 5.0×3.0cm tear, was found oil the posterior wall of the left common iliac aneurysm, surrounded by a huge hematoma. The aneurysm was resected and the abdominal aorta and the common iliac arteries were replaced with a Bard Albumin-coated DeBakey vascular bifurcated graft (16×8mm). The postoperative course was uneventful.

A Case of Chronic Contained Rupture of Infrarenal Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A chronic contained rupture of an infrarenal abdominal aortic aneurysm eroded a lumbar vertebra. A 53-year-old man complained of severe back pain for 6 months. Recently the back pain had increased. The patient looked well but a pulsatile mass in the abdomen was palpable. A CT and MRI of the abdomen and lumbar spine revealed the infrarenal abdominal aneurysm which demonstrated destruction of the third and fourth lumbar vertebra. At operation, there was a true aneurysm of the native aorta with a rupture of the posterior wall, resulting in a retroperitoneal hematoma. An orifice of the ruptured pseudoaneurysma was 2×2cm in size. An aortobiiliac graft was implanted. The patient did well postoperatively and was discharged on the 32nd postoperative day.

An Operative Case of Chronic Contained Rupture of Abdominal Aortic Aneurysm with Retroperitoneal Hematoma Distended Assembling a Giant Tumor / 日本心臓血管外科学会雑誌

We report the operative treatment of a chronic contained rupture of a saccular abdominal aortic aneurysm with a retroperitoneal hematoma. A 62-year-oldman walked into our hospital complaining of a painless abdominal mass and intermittent claudication. He had an episode of severe abdominal pain about 2 years prior to admission. A giant retroperitoneal neoplasm was suspected initially based on computed tomography (CT). However, magnetic resonance imaging, angiography and color doppler sonography demonstrated a chronic contained rupture of an abdominal aortic aneurysm. At laparotomy, a punched out oval defect (width 3.5cm×length 4.5cm) that was thought to connect the thrombosed aneurysm to an organized retroperitoneal hematoma was discovered in the posterior wall of the bifurcation of the aorta. An infrarenal aorto-biexternal iliac Y-graft with a bypass to the left femoral artery was placed without removing the aneurysm or the hematoma. Uneventful recovery followed. About one year after the operation, the retroperitoneal hematoma appeared smaller on CT scan. This case fulfilled the criteria for a “chronic contained rupture” of an abdominal aortic aneurysm proposed by Jones and associates.