ABDOMINAL AORTIC ANEURYSM RUPTURE – CASE REPORT

Abstract

An Abdominal Aortic Aneurysm (AAA) is a localized dilatation and weakening of the abdominal aorta, as it`s infrarenal part is most commonly affected by the disease. Risk of rupture: Size of the AAA is one of the strongest predictors of rupture, as aortic aneurysms above 5,5cm in diameter have a higher risk. Clinical manifestation: Most of the AAAs have no symptoms and are accidently found. Classis symptoms of ruptured AAA (rAAA) are suddenly occurring severe abdominal and/or back pain, arterial hypotension and pulsatile abdominal mass. Preoperative management: When rAAA is suspected, the patient should be consulted with a vascular surgeon as soon as possible. Aggressive fluid resuscitation should be avoided. Surgical treatment: Open surgery is usually performed via a transperitoneal approach with a midline laparotomy. Depending on the anatomy of the AAA and iliac arteries involvement an aorto-arotal or aorto-bifemoral bypass is constructed. Complications after repair of rAAA: Local - Lower limb(s) ischemia, Ischemia of the colon; Systemic - Cardiac, Pulmonary, Renal, Liver or Multiorgan failure, with 30-day mortality reaching up to 89%.
CASE REPORT: Male patient, 81 years of age, with multiple concomitant diseases. He was diagnosed with AAA 4 months prior to the rupture. The maximal diameter of the AAA was 15,6cm, iliac arteries were not affected. The patient refused the suggested surgical or endovascular treatments. He presented at ER 4 months later with acute pain in the abdomen and back. Clinical status: severe pain in the abdomen, BP 96/57mmHg, Hgb 102 g/l with HCT -0.331 l/l. On the CT-angiography rupture of AAA was verified with massive retroperitoneal haematoma, occluded right renal artery and aneurysm of the left renal artery. Median laparotomy was conducted under common anaesthesia. Aneurysmal neck was clamped above renal arteries, with clamping time – 30 minutes. After reclamping aorto-bifemoral bypass was constructed. Postoperatively the patient was transferred to intensive care unit (ICU). In the course of ICU treatment, the patient was inadequate and lacked spontaneous diuresis. A temporary catheter for haemodialysis was placed and such was initiated. He was transferred in the Clinic of vascular surgery after stabilizing blood oxygen saturation. The patient was inadequate at the time of transfer, with jaundice present. The patient restored bowel passage, hepatoprotectors were administered and physiotherapy was initiated. On the 20th postoperative day, the patient had a rapid decline in the physical status, demonstrated by hypotonia, bradycardia and regardless of the reanimation, died.
DISCUSSION: Ruptured aneurysm of abdominal aorta has high mortality. Despite the immediate surgical treatment and adequate substitution, the patient had lethal outcome.
CONCLUSION: Ruptured abdominal aortic aneurysm has high 30-day mortality, ranging between 22,9%-65,9%. In cases of acute renal and/or liver failure following the surgical treatment and when haemodialysis is needed, mortality rate can reach up to 89%.