Injury to the abdominal aorta during laparoscopic surgery: an unusual presentation

IMPLICATIONS: Laparoscopic cholecystectomy is a very common surgical procedure, and vascular injuries account for one third of major complications during this surgery. We describe an unusual presentation of an abdominal aorta injury.     

Hypoplasia of the abdominal aorta

A case of a 10 year old girl with hypoplasia of the inter-reno-mesenteric region of the abdominal aorta, which was accompanied by other pathological entities, is reported. The classification, etiology, clinical manifestations and diagnosis is discussed in detail. Successful treatment was accomplished with aorto-aortic bypass grafting and additional saphenous vein bypass from the aorta to the right renal artery. The conclusion of this study is that the hypoplasia of the abdominal aorta is a rare disease which may affect beyond the confines of the aorta and may involve the origins of vital arteries. Surgery offers the only chance of a favourable outcome.     

Coarctation of the abdominal aorta

Coarctation of the abdominal aorta constitutes a rare group of vascular abnormalities, including segmental stenoses and extended hypoplasia. Hypertension is the usual solitary clinical finding and contrasts with the diversity of anatomic lesions and surgical techniques used for treatment. It is often difficult to determine whether the lesion is congenital or due to Takayasu's aortitis. Three cases of hypoplasia in adolescents are reported. Treatment consisted of an aortoaortic bypass in all cases. Vein angioplasty of the renal arteries was performed concomitantly in one case of inter- and infrarenal hypoplasia associated with stenosis of the two renal arteries. In one of the two cases of suprarenal hypoplasia, the celiac axis was reimplanted after excision of an associated aneurysm. In all three cases, blood pressure returned to normal values without medical treatment.     

Coarctation of the abdominal aorta

Coarctation of the abdominal aorta remains a surgically treatable cause of hypertension in children and young adults. Average age of the patients is 21 years at the time of diagnosis and a second peak in the fourth to fifth decade. If left untreated, most patients die as a result of complications from untreated hypertension by the age of 35 years. Aortography remains the diagnostic test of choice with associated visceral and renal artery stenoses occurring in 26% of cases. Of the 146 cases reported, 109 had surgical treatment with an operative mortality rate of 6.9%. Of those patients having surgery 96% were normotensive or were easily controlled postoperatively with antihypertensive medications. Because claudication is a minor problem in most cases, surgical correction of the hypertension by hepatorenal or splenic-renal bypasses may be the preferred initial surgical treatment in patients without significant visceral artery involvement or severe symptomatic lower extremity ischemia.     

Coarctation of the abdominal aorta

Four patients with suprarenal coarctation of the abdominal aorta were managed from 1978 to 1993 (mean follow-up 8.75 years). Ages at the time of diagnosis were 2 months, 8 months, 4.5 years, and 15 years, respectively. Three children presented with severe hypertension, two of whom were in congestive heart failure, and the fourth child presented with a cold, ischemic leg. The 8-month-old patient had Williams syndrome (supravalvular aortic and pulmonic stenosis, bilateral renal artery stenosis and celiac artery occlusion, elfin facies, and mental retardation) and was treated nonoperatively. After 12 years of follow-up, he was given five medications to control hypertension, cardiac arrhythmias, and heart failure. Three patients with abdominal aortic coarctation were treated operatively and none died. Two patients underwent bypass grafting from the supraceliac aorta to the infrarenal aorta, with bilateral renal artery reconstruction in one. Postoperative arteriograms obtained 1 year or more after operation were normal in both cases. The 2-month-old patient underwent patch aortoplasty, with subsequent reoperation 1.5 years later for recurrent hypertension and heart failure with a bypass graft to the left kidney and removal of an infarcted right kidney. In all three patients, operative repair of the suprarenal aortic coarctation has resulted in long-term control of blood pressure and cardiac and renal function.