Chronic contained rupture of an abdominal aortic aneurysm mimicking a retroperitoneal tumor

Abstract

Chronic contained rupture of an abdominal aortic aneurysm (AAA) is a rare event that is difficult to diagnose due to the atypical and chronic symptoms. We report a case of chronic contained rupture of AAA mimicking a retroperitoneal tumor in a 36-year-old man. The patient presented with weight loss and chronic lower abdominal pain, and was referred to our clinic with a suspected retroperitoneal tumor. Abdominal computed tomography (CT) revealed a distinct mass measuring 15 x 10 x 10 cm in the left retroperitoneal space, involving the abdominal aorta. One week later he experienced sudden abdominal pain radiating to the back. He was subsequently diagnosed with ruptured AAA and aortic dissection. The patient received implantations of both common iliac arteries to the abdominal aorta using Y-grafts and an ascending-to-descending aortic graft in a two-stage operation. His recovery from surgery was uneventful.

腹部大動脈瘤に伴うchronic contained ruptureは稀な症状であるが, 慢性の非定型的な症状を呈し時に診断が困難である。われわれは後腹膜腫瘍と類似した36歳男性例を経験したので報告する。患者は体重減少と腹部鈍痛を主訴に後腹膜腫瘍の疑いにて当科紹介となった。腹部CT検査で左後腹膜腔に10×5×10cmの腫瘤性病変を認め, これは腹部大動脈を巻き込んでいた。精査中1週間後に背部に放散する強い腹痛が出現, 緊急腹部CT検査を施行し解離性大動脈瘤破裂と診断した。血管外科で緊急手術を施行し左右総腸骨動脈と腹部大動脈間をYグラフトで置換した。二次的に上行下行大動脈グラフト置換術も施行した。(著者抄録)