1/23. Transabdominal inguinal hernioplasty combined with abdominal aortic aneurysm repair.The number of patients being encountered with abdominal aortic aneurysm (AAA) and inguinal hernia is increasing. We describe herein a technique of performing a concomitant one-stage operation for both disorder. After conventional transperitoneal AAA repair, transabdominal preperitoneal hernia repair is carried out through the same incision using a prosthesis made from the same material as the graft used for AAA. The maneuver is similar to that of laparoscopic hernioplasty. We employed this technique in the treatment of four patients, none of whom developed any complications such as infection or recurrence of the inguinal hernia. Thus, we conclude that this one-stage operation for AAA and inguinal hernia may bring physical and economic benefits to patients who have both diseases concomitantly.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/23. Abdominal aortic aneurysm compression is probably responsible for the recurrent episodes of acute pancreatitis: case report.An aged male with a known history of abdominal aortic aneurysm suffered from epigastralgia, vomiting and cold sweating for one day. According to the physical examination, serum amylase level and computed tomographic examination, acute pancreatitis was diagnosed. Surgical intervention for the abdominal aortic aneurysm was not performed because of his age, and finally this patient died after three recurrent episodes. Acute pancreatitis co-existing with an intact abdominal aortic aneurysm has never been reported before. The possible pathogenesis of this recurrent acute pancreatitis was discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/23. Primary aortoduodenal fistula complicated by abdominal aortic aneurysm.A 74-year-old male patient was operated in Vakif Gureba Hospital for aortoduodenal fistula developing from abdominal aortic aneurysm. The patient was diagnosed as abdominal aortic aneurysm after physical examination and computed tomography in another center. Appearing of melena and hematemesis gastroduodenoscopy and radionuclide scanning was performed as diagnosis. After 6 days gastrointestinal bleeding recurred in massive haemorrhage and the patient was operated with a diagnosis of aortoenteric fistula as emergency. A midline laparotomy was performed. There was a fistula between infrarenal abdominal aortic aneurysm (with diameter 8x10 cm) and the 3rd portion of the duodenum. The duodenum was resected segmental and the fistula was disconnected. Following aneurysmotomy a prosthetic graft was placed in the aortobiiliac position. The patient was discharged at the 42nd postoperative day. Primary aortoenteric fistula is a very rare consequence of untreated abdominal aortic aneurysm. The segments of intestine most frequently involved in aortoenteric fistula are the 3rd and 4th portions of the duodenum. Clinical presentation is recurrent episodes of gross gastrointestinal haemorrhage. These cases have high mortality and morbidity unless evaluated as quickly as possible and appropriate surgical intervention performed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/23. ehlers-danlos syndrome type IV and multiple aortic aneurysms--a case report.Beside atherosclerosis, aortic aneurysms can be part of the clinical spectrum of many systemic diseases, including infectious, inflammatory, genetic and, less often, congenital disorders. A 48-year-old white man presented with multiple large aneurysms of the aorta and its main branches. Medical history was unremarkable except for the presence of a softened abdominal mass since he was 28 years old. On the physical examination, an arterial murmur was heard over the left carotid artery and a palpable mass was noted in the whole right side of the abdomen. No skin or joint abnormalities were noted. aortography, computed tomography, and magnetic resonance angiography showed multiple large aneurysms of the descending thoracic and abdominal aorta. Aneurysms of the innominate, left subclavian, and carotid arteries were also seen. This case resembles those previously reported, in which multiple aortic aneurysms were associated with abnormalities of the type III procollagen gene (COL3A1). Although the classic stigmas of the ehlers-danlos syndrome type IV were lacking, this genetic disease may be the cause of the multiple aneurysms in this patient.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/23. Impact of management of abdominal aortic dissection following the successful operation of annulo-aortic ectasia in Marfan's syndrome--a case report.A 21-year-old female patient with Marfan's syndrome suffering from chronic ascending aortic dissection and aortic insufficiency was treated with total aortic root replacement by Cabrol technique (or procedure). The post-operative course was smooth and the patient recovered satisfactorily with very stable hemodynamic condition and good appetite. Unfortunately she complained of sudden severe abdominal pain followed by complete anuria on the fifth post-operative day. The MRI demonstrated abdominal aortic dissection with malperfusion of all the abdominal organs. Rapid increase of aminotransferases (SGOT and SGPT), severe acidosis and rapid deterioration of vital signs within 10 hours discouraged us from trying surgical intervention. The puzzle of management in those cases will be discussed.- - - - - - - - - - ranking = 0.6760935711163keywords = suffering (Clic here for more details about this article) |
6/23. Spontaneous aortocaval fistula.Spontaneous aortocaval fistula is rare, occurring only in 4% of all ruptured abdominal aortic aneurysms. The physical signs can be missed but the presence of low back pain, palpable abdominal aortic aneurysm, machinery abdominal murmur and high-output cardiac failure unresponsive to medical treatment should raise the suspicion. Pre-operative diagnosis is crucial, as adequate preparation has to be made for the massive bleeding expected at operation. Successful treatment depends on management of perioperative haemodynamics, control of bleeding from the fistula and prevention of deep vein thrombosis and pulmonary embolism. Surgical repair of an aortocaval fistula is now standardised--repair of the fistula from within the aneurysm (endoaneurysmorraphy) followed by prosthetic graft replacement of the aneurysm. A case report of a 77-year-old woman, initially suspected to have unstable angina but subsequently diagnosed to have an aortocaval fistula and surgically treated successfully, is presented along with a review of literature.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/23. Mechanical trauma as a cause of late complications: after AneuRx Stent Graft repair of abdominal aortic aneurysms.We present a series of 4 patients in whom mechanical trauma was identified as a factor in the development of late complications after AneuRx Stent Graft placement for repair of abdominal aortic aneurysms. In all 4 patients, Type I or III endoleaks (and pseudoaneurysms in 2 patients) were discovered several months after abdominal aortic aneurysm repair with the AneuRx device. Two patients had sustained blunt abdominal trauma in a car accident one had suffered a traumatic fall, and another had been participating in vigorous rowing activity. In all patients, the trauma had occurred several months before the diagnosis of endoleak or pseudoaneurysm (or both) was established. In all patients, follow-up computed tomographic scans identified the complications. In conclusion, blunt mechanical injury is an unrecognized factor contributing to the late failure of endovascular stent grafts. Vigorous physical activity may also contribute to graft disruption or to the separation of modular components.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/23. CT features of chronic contained rupture of an abdominal aortic aneurysm.Four cases among the 149 patients who required repair of an infrarenal abdominal aortic aneurysm (AAA) during the last five years, were chronic contained rupture. The first symptom at onset was back pain and physical examination revealed the patients to be in no acute distress. The sites of rupture were posterior in all cases. They were operated through an extraperitoneal approach. There was no operative mortality and all survived. The CT features, (1) discontinuity of the rim of calcification in the true aneurysm wall, (2) well defined soft tissue density adjacent to the aorta, (3) the concealed psoas muscle and the displaced viscera depending on the size of the lesion, and (4) no appearance of contrast material in the hematoma in some cases, led to the correct diagnosis of contained rupture.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/23. Perineal bruising: a sinister sign for leaking iliac aneurysms?Ruptured false iliac aneurysms carry high mortality of up to 57%. It should be suspected whenever a patient who had previous aortic aneurysm repaired presents with bizarre lower abdominal symptoms. In the literature, different presentations have been reported, e.g progressive hydronephrosis, small intestinal obstruction, chronic venous insufficiency, arterio-venous fistula, and gross haematuria from arterio-vesical fistula. We report a patient suffering from a ruptured iliac aneurysm associated with a new sign that has not been described hitherto: perineal bruising.- - - - - - - - - - ranking = 0.6760935711163keywords = suffering (Clic here for more details about this article) |
10/23. Infrarenal abdominal aortic aneurysm complicated by persistent endotension after endovascular repair: report of a case.endoleak and endotension may prevent the successful exclusion of an aneurysm after endovascular aortic aneurysm repair (EVAR). The pressurization in the excluded aneurysm sac caused by endotension may lead to rupture of the aneurysm; however, the cause of endotension and its underlying mechanisms remain unclear. We report a case of infrarenal abdominal aortic aneurysm (AAA) complicated by persistent endotension after EVAR. Although no endoleaks were found on conventional double-phase computed tomographic scans, a thrombosed endoleak existed in the side branch and attachment site of the endograft. After treating the undetectable thrombosed endoleaks, physical examination revealed that the pressure of the excluded aneurysm had diminished, with shrinkage of the aneurysm. This case report suggests that a high-pressure undetectable type I or type II endoleak could be a major cause of endotension. Thus, postoperative evaluation of the attachment site of an endograft is important after EVAR.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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