A Chronic Contained Rupture of an Abdominal Aortic Aneurysm Complicated with Severe Back Pain

Nakagawa, Y; Masuda, Masahisa; Shiihara, H; Furukawa, Hiroyoshi; Hayashida, Nobuaki; Kasegawa, Hitoshi; Abé, Hiroyuki; Okui, Katsuji

doi:10.1007/bf02001378

Cited by 22 publications

(6 citation statements)

References 13 publications

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“…25 The preoperative finding of the organized retroperitoneal hematoma detected by duplex ultrasonography, CT, or MRI is the most important preoperative sign of chronic contained RAAA. 27 Sometimes that hematoma is described as a “lobular mass” 15,28 or a “pseudoaneurysm.” 29 The angiography can show a “saccular” AAA or compression on the renal arteries or inferior vena cava. 15,25,28,29 The surgical treatment of chronic contained RAAA is simpler owing to hemodynamically stable patients.…”

Section: Discussionmentioning

confidence: 99%

“…27 Sometimes that hematoma is described as a “lobular mass” 15,28 or a “pseudoaneurysm.” 29 The angiography can show a “saccular” AAA or compression on the renal arteries or inferior vena cava. 15,25,28,29 The surgical treatment of chronic contained RAAA is simpler owing to hemodynamically stable patients. The operative mortality rate in the case of chronic contained RAAAs is lower in comparison with the typical form; however, they both require urgent treatment.…”

Section: Discussionmentioning

confidence: 99%

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Unusual Forms of Ruptured Abdominal Aortic Aneurysms

et al. 2008

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Over 95% of abdominal aortic aneurysms (AAAs) rupture into the retroperitoneal space. Rare types of AAA ruptures comprise ruptures into the inferior vena cava with aortocaval fistula formation (ACF), ruptures into the duodenum with formation of a primary aortoduodenal fistula (ADF), and chronic contained ruptures (CCRs). This article presents a study of 41 cases with unusual forms of ruptured AAA of a series of 506 patients with AAA rupture treated within a 14-year period. There were 11 cases of CCR, 5 cases with ADF, and 25 cases with ACF. The correct preoperative diagnosis was established in 6 (of 11) cases of CCR, in 2 (of 5) cases of primary ADF, and in 13 (of 25) cases of ACF. AAA replacement was performed in 8 cases using a tube graft, whereas a bifurcated graft was used in 31 patients because of the distant extent of the atherosclerotic/aneurysmatic lesions engaging iliac arteries. Two patients had an axillobifemoral bypass. The overall 30-day mortality rate was 19% (8 of 41), with subgroup mortality rates of 0 (CCR), 60% (ADF), and 20% (ACF). Diagnosis and treatment are simplest in cases of CCR and the most complicated in cases of ADF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Unusual Forms of Ruptured Abdominal Aortic Aneurysms

et al. 2008

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“…Numerous individual cases of back and/or abdominal pain as a result of abdominal aortic aneurysm, 4,9,14,28,30,35 intestinal obstruction, 13 duodenal ulcer, 37,40 cancer, 7,31,37 and hematometra 15 have been reported in the literature. The urgent concern for the physician in the case presented in this paper was to rule out a possible abdominal aortic aneurysm or intestinal obstruction.…”

Section: Pathologymentioning

confidence: 99%

Abdominal Differential Diagnosis in a Patient Referred to a Physical Therapy Clinic for Low Back Pain

Stowell¹,

Cioffredi²,

Greiner³

et al. 2005

J Orthop Sports Phys Ther

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Study Design: Resident's case problem. Background: Acute back pain most often presents as musculoskeletal in nature; however, less frequently it may be the result of an underlying, or coexisting, systemic pathology. When present, the signs and symptoms of systemic pathology can mimic, or be masked by, musculoskeletal back pain, which may pose a diagnostic challenge during the clinical evaluation. The purpose of this resident's case problem is to describe the clinical reasoning process leading to a medical referral for a patient who presented to physical therapy with debilitating low back pain. Diagnosis: The patient in this resident's case problem was a 67-year-old male referred to physical therapy with a 2-week history of severe low back pain and muscle spasms. The patient history and physical examination were suggestive of musculoskeletal back pain and physical therapy treatment was initiated. Abdominal pain was elicited during an introductory therapeutic exercise, which was recognized by the therapist as a potential sign of abdominal pathology. The therapist performed an additional review of systems and an abdominal screening examination, which established the necessity of an immediate medical referral. At the emergency department, ominous abdominal pathology was safely ruled out through diagnostic imaging and the patient was treated for secondary gastrointestinal effects of opioid analgesic medications. Discussion: This resident's case problem provides an opportunity to discuss the clinical reasoning process leading to the suspicion of abdominal pathology. Specifically, this case reinforces the importance of recognizing potential signs of systemic pathology, executing an appropriate physical examination, including screening of the involved anatomical region, and providing an appropriate medical referral when indicated. J Orthop Sports Phys Ther 2005;35:755-764. Key Words: differential diagnosis, low back, lumbar spine evaluation, pharmacology, primary care L ow back pain accounts for a large proportion of primary care visits and ranks second only to the common cold. 23 Jette et al 24 reported that greater than 25% of patients presenting to outpatient physical therapy settings do so as a result of back pain. Back pain is the most common cause of short-term disability in adults younger than 45 years and is the second most common cause in adults aged 45 to 65 years. 20 Clinical assessment of acute low back pain is often puzzling as a result of the varying intensity

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“…In addition, the chronic bulging of the pseudoaneurysmal sac results in mechanical compression of these surrounding structures and leads to undefined lumbar vertebral erosion and lower back pain. This pain might radiate to the testes, back, inguinal region, or hip due to the direct irritation of the psoas muscle 5 – 8 . This rare clinical presentation of such a pathology (<100 documented cases worldwide) renders making a diagnosis a difficult endeavor and this results in potentially life-threatening complications mostly due to the freeing of the anatomically contained hematoma 9 .…”

Section: Introductionmentioning

confidence: 99%

Chronic contained ruptured abdominal aortic aneurysm with a rare presentation of lower limb neuropathic claudication: a report of two cases

Hariri

Laham

Mohammad

2023

Annals of Medicine &Amp; Surgery

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Introduction and importance: A vertebral body erosion that takes place due to a chronic contained rupture of an abdominal aortic aneurysm is an especially rare vascular pathology that comprises less than 5% of all causes of vertebral body erosion. Chronic contained rupture of an abdominal aortic aneurysms are primarily observed in hemodynamically stable patients whose chief complaint is lower limb neuropathic pain. This entity is extremely misleading and this results in delayed management of those patients increasing the morbidity and mortality rates. Case presentation: We present the two cases of 62-year-old and 65-year-old males. Preoperative radiology for each patient showed an infrarenal aortic aneurysm with a retroperitoneal hematoma in contact with the lumbar vertebral bodies and psoas muscle. The draped aorta sign was evident in both cases. Clinical discussion: A curative surgical intervention was accomplished for both patients, respectively. This was achieved through the removal of the existing hematomas that were compressing the vertebrae in addition to the complete isolation and resection of the respective abdominal aortic aneurysms along with thorough reconstruction of the aortoiliac spindles with patent synthetic grafts to ensure the patency of the preexisting vascular axis. Conclusion: A contained rupture of an abdominal aortic aneurysm is a rare occurring vascular pathology that manifests with nonspecific symptoms, such as femoral neuropathy and lower back pain proportionate to the degree of the level of erosion of the affected lumbar vertebrae. This will increase the possibility of misdiagnosis and delays in treatment. Such a life-threatening vascular emergency should be timely detected and treated to avoid its complications and patient mortality.

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A Chronic Contained Rupture of an Abdominal Aortic Aneurysm Complicated with Severe Back Pain

Cited by 22 publications

References 13 publications

Unusual Forms of Ruptured Abdominal Aortic Aneurysms

Unusual Forms of Ruptured Abdominal Aortic Aneurysms

Abdominal Differential Diagnosis in a Patient Referred to a Physical Therapy Clinic for Low Back Pain

Chronic contained ruptured abdominal aortic aneurysm with a rare presentation of lower limb neuropathic claudication: a report of two cases

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