Chronic contained rupture of an abdominal aortic aneurysm

The operative treatment of chronic contained rupture of a saccular abdominal aortic aneurysm (AAA) with retroperitoneal haematoma is reported. A 62-year-old man presented with a painless abdominal mass and intermittent claudication. He had an episode of severe abdominal pain about 2 years before admission. A giant retroperitoneal neoplasm was initially suspected, based on computed tomography. However, magnetic resonance imaging, angiography and colour Doppler sonography demonstrated chronic contained rupture of an AAA. A punched-out oval defect (width 3.5 cm × length 4.5 cm) that was thought to connect the thrombosed aneurysm to an organized retroperitoneal haematoma was discovered in the posterior wall of the bifurcation of the aorta at laparotomy. An infrarenal aortobiexternal iliac Y-graft with bypass to the left femoral artery was placed without removing the aneurysm or haematoma. Recovery was uneventful. The retroperitoneal haematoma appeared smaller on computed tomography about 1 year after operation. This case fulfulled the criteria for chronic contained rupture of an AAA proposed by Jones and associates.     

Chronic contained rupture of an aortic aneurysm mimicking infective spondylitis

Chronic contained rupture of an abdominal aortic aneurysm is rare. These aneurysms are small and affected patients are usually normotensive. The resultant pseudoaneurysmal sac may cause extensive vertebral erosion. Diagnosis is often delayed as the condition may present with symptoms referable to the lumbar spine. This report is of two cases cases where the initial diagnosis was infective spondylitis.     

Chronic contained abdominal aortic aneurysm rupture after suprarenal fixation fatigue fracture

Chronic contained rupture (CCR) of an abdominal aortic aneurysm is a rare condition, and differential diagnosis might be difficult. We present a clinical case of a hemodynamically stable octogenarian who presented with intermittent pain in the left lower abdomen. The patient had a history of diverticulitis, and 6 years ago, he had undergone endovascular abdominal aortic aneurysm repair (EVAR) with a Talent bifurcated prosthesis. Additionally, 20 days before his admission to our hospital, he had undergone a secondary iliac limb extension for treatment of post-EVAR rupture. On admission, abdominal plain radiography identified suprarenal fixation fracture as a possible reason for CCR, but computed tomographic angiography failed to confirm any endoleak or "active" bleeding and rupture. The patient received medication treatment for possible diverticulitis and was kept under close monitoring for suspected failure of recently performed secondary endovascular procedure and CCR. A day later, the abdominal pain symptoms worsened, and a new computed tomographic angiography confirmed the suspected CCR. The patient was treated successfully by "open" repair using a Y prosthesis. To our knowledge, this is the first reported case of post-EVAR CCR due to suprarenal fixation fatigue fracture. Lifelong post-EVAR follow-up with high level of both clinical and imaging diagnostic accuracy is essential for the early recognition and proper treatment of EVAR pitfalls.     

Chronic contained rupture of abdominal aortic aneurysms

Anecdotal reports of chronic contained rupture of abdominal aortic aneurysms exist. Their existence and implications have been largely ignored. From March 1984 to March 1985, 24 patients required repair of an infrarenal abdominal aortic aneurysm. Four patients underwent emergent repair. The remaining 20 patients were evaluated with computed tomography electively. Seven patients (35%) were demonstrated to have a rupture of the aneurysm and a retroperitoneal hematoma on the computed tomographic scan. All of the patients had histories of back or flank pain; five patients continued to complain of mild pain on admission. In no case was shock, impending shock, or a decrease in the hemoglobin level present on admission. All patients were operated on within 24 hours of evaluation. At operation, rupture was noted with organized hematoma outside the aorta contained in a pseudoaneurysmal wall of retroperitoneal connective tissue. There was no intraperitoneal blood. There was no operative mortality and survival was 100% at six months. The CT scan evaluation had identified a subgroup of patients with aneurysms associated with chronic contained rupture.     

Chronic rupture of abdominal aortic aneurysm

Although the mortality rate after abdominal aortic aneurysm rupture approximates 90% despite the urgent management, a few cases of chronic rupture and delayed repair have been reported in the world literature; anatomic and hemodynamic reasons occasionally allow for the fortunate course of these patients. We report in this article the case of 76-year-old man with a ruptured abdominal aortic aneurysm who was transferred to our facility 4 weeks after his initial hospitalization in a district institution and who finally had a successful open repair.     

Chronic contained rupture of an abdominal aortic aneurysm with vertebral erosion: report of a case.

A 73-year-old man had lumbago of unknown cause for several months prior to presentation. At examination prior to surgery for gastric cancer, an abdominal aortic aneurysm (AAA) of 6 cm in maximum diameter, retroperitoneal hematoma and vertebral erosion were found on abdominal computed tomography (CT). Hematological examination revealed mild anemia and stable hemodynamics. A diagnosis of chronic contained rupture of an AAA was made and knitted Dacron bifurcated graft replacement was performed. When an intraluminal thrombosis at the posterior wall was removed, a punched-out defect (3 x 2 cm) was discovered. When the old hematoma was removed, a destroyed vertebral body was found. After surgery, the lumbago was alleviated. The patient was transferred to the Department of Surgery and a gastrectomy was performed. The patient's postoperative course was uneventful.     

Chronic contained rupture of an abdominal aortic aneurysm presenting as a Grynfeltt lumbar hernia. A case report

We report a unique case of chronic contained thoraco-abdominal aneurysm rupture presenting as a Grynfeltt lumbar hernia. A 79-year-old man presented with backpain and a bluish swelling in the left lumbar region in the presence of a non tender aortic aneurysm. CT scan confirmed contained rupture of a type IV thoraco-abdominal aortic aneurysm. The peri-aortic haematoma protruded through the lumbar wall causing a Grynfeltt lumbar hernia. The aneurysm was replaced through a thoraco-phreno-lumbotomy. The patient survived and is doing well six months postoperatively.     

CT features of chronic contained rupture of an abdominal aortic aneurysm.

Four cases among the 149 patients who required repair of an infrarenal abdominal aortic aneurysm (AAA) during the last five years, were chronic contained rupture. The first symptom at onset was back pain and physical examination revealed the patients to be in no acute distress. The sites of rupture were posterior in all cases. They were operated through an extraperitoneal approach. There was no operative mortality and all survived. The CT features, (1) discontinuity of the rim of calcification in the true aneurysm wall, (2) well defined soft tissue density adjacent to the aorta, (3) the concealed psoas muscle and the displaced viscera depending on the size of the lesion, and (4) no appearance of contrast material in the hematoma in some cases, led to the correct diagnosis of contained rupture.     

A chronic contained rupture of an abdominal aortic aneurysm complicated with severe back pain

Chronic contained rupture of an abdominal aortic aneurysm is an uncommon occurrence with the aneurysms usually small-to-moderate in size. Diagnosis may be difficult because patients present with both atypical and chronic symptoms. Pressure erosion of the lumbar spine is presumably a highly significant associated disorder, but an enhanced computed tomographic scan is the most reliable method for the correct diagnosis. We report on a 46-year-old man who developed severe back pain which was initially thought to result from spinal disease. Retrospective review of computed tomographic scans taken two years before admission revealed the beginning of the leakage of the aneurysm. Remarkably, the patient remained stable two years after the rupture.     

Adrenal hemorrhage mimicking an abdominal aortic aneurysm

The adrenal gland is the most common site of extranodal spread from primary lung cancer. We report a case of adrenal hemorrhage secondary to metastasis in a patient with primary large cell carcinoma of the lung presenting as a suspected ruptured abdominal aortic aneurysm.     

Aortocaval fistula and contained rupture of an abdominal aortic aneurysm presenting with pelvic venous congestion

This case report describes pelvic venous congestion without associated high-output cardiac failure as an unusual presentation of an aortocaval fistula as a complication of a contained rupture of an abdominal aortic aneurysm. Options for caval control and management of perioperative problems unique to this situation are discussed.     

Extension of contained rupture of an abdominal aortic aneurysm into a lumbar intervertebral disc. Case report

Chronic contained rupture of an abdominal aortic aneurysm (AAA) is a rare event, making its diagnosis difficult. A delayed diagnosis and delayed surgical repair compromise the outcome. In this paper the authors report the case of a chronic contained rupture of an AAA causing spinal destruction, in which diagnosis was difficult because the lesion produced symptoms mimicking those of pyogenic spondylitis.     

Preoperative evaluation of retroperitoneal venous system anomalies during abdominal aortic aneurysm rupture

The association of a retroaortic left renal vein and an abdominal aortic aneurysm (AAA) fistula is an infrequent event. We present two cases of AAA rupture into the retroaortic left renal vein. Preoperative computed tomography (CT) assessment showed retroperitoneal bleeding due to a large AAA rupture with an associated unusual retroaortic left renal vein. Patients underwent successful arteriovenous fistula sutures with abdominal aortoiliac replacement. The patients had uneventful recoveries, and they were discharged on the seventh to ninth postoperative day (POD) without renal complications. The clinical onset was characterized by the unique syndrome: continuous abdominal bruit, abdominal and left flank pain with an associated pulsatile mass (Mansour Triad). Moreover patients presented with haematuria, proteinuria and a large non-functional left kidney on the imaging scan. The CT-scan may suggest the presence of the venous anomaly. Unusual anatomical presentation recommends a careful surgical approach during AAA operations.     

Chronic contained leak of abdominal aortic aneurysm presenting as lumbar neuropathy.

Chronic contained rupture of aortic aneurysm is a rare event which can cause diagnostic difficulties. It can present as high lumbar neuropathy, hence, chronic contained rupture should be borne in mind while examining patients with back pain. Delayed diagnosis and delayed surgical repair of the ruptured aneurysm can compromise the final results. The outcome of urgent repair of a chronic contained leak is equivalent to that of elective aneurysm repairs.