Abdominal Aortic Aneurysm in Infant

Abstract

Abdominal aortic aneurysm (AAA) is rare in infants and children, with only 35 cases previously reported in the world literature. A few may be congenital in origin but most of them are mycotic, arising from septic complications following umbilical artery catheterization. With prompt diagnosis and surgical repair, excellent results can be achieved. Case ReportA male child aged seven months presented with a pulsatile mass in the lower abdomen. He was premature at birth and required treatment for respiratory distress syndrome that included umbilical artery catheterization. He otherwise appeared normal, and apart from the abdomen, physical examination was unremarkable. The abdominal mass measured approximately 6 cm in diameter and extended from the mid-abdomen into the pelvis. Abdominal ultrasound demonstrated infrarenal abdominal aortic aneurysm measuring 3.5 cm anteroposterially and 6.5 cm in length.Angiogram confirmed the presence of a large saccular aneurysm of the distal aorta extending down into the pelvis and partially filled with clot. Severe stenosis of proximal iliac vessels and distal aortic aneurysm, but apparently normal external iliac and femoral arteries, were demonstrated on CT angiogram (Figure 1). Other investigations including cardiac echo and blood cultures, CBC, ESR, renal and hepatic profiles were normal.The abdomen was opened through a transverse incision. The saccular aneurysm was resected and the aorta was patched with polytetrafluorethylene (PTFE). The left common iliac artery was very small and underdeveloped, while the right common iliac appeared to be normal. The patient's postoperative recovery was uneventful, and he was discharged home. A postoperative CT angiogram demonstrated excellent blood flow through the iliac vessels, and the appearance of the aorta revealed no residual aneurysm (Figure 2). Long-term follow-up of about three years showed good blood flow to both legs and no recurrence of the aneurysm.