Open Repair of Ruptured Huge Aorto-Iliac Aneurysm: Warning of Colon Ischemia

Abstract

A giant abdominal aortic aneurysm (AAA) renders surgical treatment much more difficult by deforming the proximal infrarenal aortic neck (shortened length and disturbed angulation), by altering the iliac arteries (marked tortuosity and aneurysmal dilatation), and by displacing abdominal organs. Because the retroperitoneal rupture of giant AAA makes the mesentery more elongated and deformed, compromising its blood flow and thus increasing the risk of mesenteric ischemia such as colon ischemia. We describe here the surgical repair of a large infrarenal AAA with a ruptured huge left common iliac artery aneurysm of 13.5 cm in diameter, accompanied by colostomy due to colon ischemia which occurred during the operation. We discuss the pathophysiology and preventive strategy of colon ischemia during ruptured giant AAA repair.

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.…”

Lower extremity weakness as the first sign of an abdominal aortic aneurysm

“…Open surgery for giant aneurysms is a challenge in itself because of the limited space, distortion of the normal anatomic structures in the abdominal cavity, reduced operative field, extreme neck angulation, short neck length, and adhesions to adjacent structures. 5 Medulla spinalis arterial vascularization consists of an extramedullary network and intramedullary arteries. Afferent arteries originate on multiple sites, according to the medullary level.…”

A Case of Giant Aortoiliac Aneurysm Rupture when Open Repair Seems a One-Way Street

“…Extreme angulation, large diameter, short length, and significant thrombus burden, all may accompany the extreme dimensions of the aneurysmal sac. 3 The anatomical suitability for endovascular treatment of ruptured AAA is reported at 46%. 4 Additionally, in the EUROSTAR (European collaborators on stent/graft techniques for aortic aneurysm repair) registry, larger (nonruptured) aneurysms were associated with increased incidence of endoleaks following endovascular repair, especially when there is concomitant aneurysmal pathology in abdominal aorta and iliac arteries.…”