Ruptured Abdominal Aortic Aneurysm Associated with Left Colon Gangrene and Neurological Disorders, a Very Rare and Life-Threatening Combination.

Abstract

Background: We report the management of a very rare combination of two severe surgical emergencies, ruptured aortic aneurysm with gangrene of the left colon. Both events separately present a high mortality rate in ruptured aortic aneurysms with 48.5%.
 Case report: We present the case of a 59-year-old woman that was admitted to the service of Emergencies at University Hospital Center “Mother Theresa” of Tirana on January 4th of 2013, after being transferred from the Regional Hospital of Durres diagnosed with ruptured aortic aneurysm based on an unclear CT. The patient arrived in a state of profound hypovolemic shock after suffering cardiac arrest and underwent resuscitation at the ICU of Durres Hospital ( no exact information of the anoxic brain time).
 After a brief volemic compensation in our ICU, the patient was taken to the operating room. Intraoperatively we found an infrarenal r AAA and gangrene of the sigmoid and left colon. Resection and reconstruction by the interposition of a tube graft were performed, followed by a left large hemicolectomy with temporary colostomy realized by the team of general surgeons. Three months later they performed colorectal-anastomosis as a second step operation.
 Postoperatively the patient had a period of 3 weeks stay in the ICU, mostly due to neurological complications after the ischemic stroke, and on January 29 of 2013, she returned to the Service of Neurology at the Hospital of Durres for further neurological rehabilitation. One year later, in the ambulatory routine check, the patient presented full recovery from surgery and a complete central and peripheral neurological rehabilitation.
 Conclusions: Ruptured aortic aneurysm with gangrene of the left colon is a very rare and severe combination caused by the hypoperfusion of the inferior mesenteric artery in the presence of hypovolemic shock and insufficient collateral circulation. The strategy of treatment includes fast diagnosis, short hypotensive resuscitation, cell-saving and autotransfusion, and the simplest possible surgical reconstruction for both emergencies.