Huge infra renal abdominal aortic aneurysm presented with concomitant divirticular abscess: A case report

Abstract

IntroductionIt is a controversial and difficult problem for a surgeon to manage the simultaneously occurring diseases divirticular abscess and abdominal aortic aneurysm. Mostly surgeons are not willing to execute a non vascular procedures during the repair of an aneurysm because there can be a risk of graft infection.Presentation of caseIn this case study, we have explained about the presentation of a huge infrarenal abdominal aortic aneurysm (AAA) that is found to be associated with a divirticular abscess and both needed an intervention.DiscussionIt has been suggested by various evidences that a one-stage elective surgical treatment is safer and cost effective for the treatment of patients with an abdominal aortic aneurysm associated with other problems like gastro-intestinal malignancies. However, the high risk of graft infection made the two staged procedure a popular option.ConclusionThe major dilemma is in the management of patients with large aneurysm which require an urgent repair and presented with concomitant pathologies that carry a high risk of sepsis. In this case report, we described an unusual presentation of a large aneurysm with a concomitant divirticular abscess where both needed an urgent intervention.

Abdominal aortic aneurysm and acute appendicitis: a case report and review of the literature

“…We think that our case is very different from that of Al Samaraee et al [ 3 ], since the appendicitis changed from phlegmonous to perforated with local peritonitis. The case reported by Al Wahbi and Tamimi in 2015 [ 25 ] is similar to ours, where the patient, a 71-year-old man, had a huge AAA (10 cm diameter) concomitant with a diverticular abscess in the right iliac fossa. Initially, percutaneous drainage guided by ultrasound was performed in conjunction with antibiotic therapy (and other measures).…”

A systematic review and case presentation: Giant abdominal aortic aneurysm

“…15,64 With open laparotomy, aortic cross-clamping is frequently difficult, and decreased surgical exposure can lead to unwanted traction upon the aneurysm neck or adjacent organs leading to increased venous injury, pancreatitis, and bowel injury may occur. 65 Simultaneously occurring conditions make AAA management challenging such as concomitant aortic dissection – case presented by Xu et al, 66 diverticular abscess, and abdominal aortic aneurysm, where percutaneous drainage of the abscess under ultrasound guidance was performed to drain abscess – Al Wahbi and Tamimi 67 horseshoe kidney, 62 in a Jehovah’s Witness, use of blood obtained by continuous cell salvage technique and the sixth postoperative day, recombinant human erythropoietin (epoetin beta) was commenced, 68 staged cardiac operation for ischaemic cardiomyopathy and performing abdominal aneurysmectomy first on cardiopulmonary bypass – mildly hypothermic (34° 8C) full-flow bypass by Pocar et al 69 Utilization of hypothermic cardiac bypass – Vural et al 70 suggest it as a useful method in giant AAA, operations where simple aortic clamping is not sufficient for AAA repair and repair of diseases TAA and AAA performing anastomosis with a bloodless surgical field without proximal clamping. 71–73 Complications were reported in cases 21 (35%) including multi-organ failure, ARDS, paralytic ileus, wound infection/dehiscence, ischaemic colitis, jaundice erectile dysfunction, gastric erosions, perigraft seroma, and graft infection enlisted in Table 3.…”

A mixed method study to validate a two-way feedback between student and faculty to improve learning of anatomy

“…Anatomy is one of the oldest basic medical sciences, it is considered core to medicine as well as some associated and complementary health disciplines [ 11 ]. Anatomy teachers continually look for implementing effective teaching and learning techniques that give the students a more interesting and advantageous experience in the course.…”