Rupture of an abdominal aortic aneurysm in a patient with a situs inversus totalis: Report of a case

Abstract

An 80-year-old woman was admitted to our hospital complaining of severe abdominal and back pain. Computed tomography (CT) showed an 8.5 x 7.0-cm infrarenal abdominal aortic aneurysm (AAA) with a large contained retroperitoneal hematoma. Known situs inversus totalis was reconfirmed by CT. Just after the CT examination, the patient collapsed and was immediately taken to the operating room. Her hemodynamics stabilized after clamping of the descending aorta via a right anterolateral thoracotomy. A resection of the abdominal aneurysm and prosthetic graft replacement were successfully performed. To our knowledge, there has been no other report of a ruptured AAA in a patient with situs inversus totalis.

Changes in laboratory values and their relationship with time after rupture of an abdominal aortic aneurysm

“…[1][2][3][4][5][6][7][8] Multiple-organ failure (MOF) is the major cause of death in the intensive care unit (ICU) after successful RAAA repair. 9,10 Consequently, there are many associated laboratory abnormalities.…”

Repair of a juxtarenal abdominal aortic aneurysm in a patient with situs inversus totalis using a retroperitoneal approach

“…The presence of AAA in situs inversus is uncommon, with only a small number of case reports describing this condition. [5][6][7][8][9] Consequently, the ideal surgical approach in a patient with SIT and AAA is unknown. Kimura et al described performing a right-sided thoracotomy with proximal aortic cross-clamping to gain vascular control in a patient with SIT and aneurysmal rupture.…”

“…Kimura et al provided similar justification for performing a right thoracotomy with cross-clamping of the descending thoracic aorta in the setting of rupture. 8 In an acute situation, this was deemed to be faster and safer than contending with mirror image anatomy while gaining supraceliac control through a transperitoneal approach. 8 Other anatomic and physiologic considerations must be taken into account in approaching a patient with SIT.…”

Successful Endovascular Infrarenal Aneurysm Repair in a Patient With Situs Inversus Totalis

“…Kato et al year-old lady, requiring clamping of the descending thoracic aorta to achieve proximal aortic control. 5 This is, to our knowledge, the first case in the world's literature on a successful elective endovascular infrarenal aneurysm repair in a patient with situs inversus totalis.…”