Case report Br. J. Surg. 1992, Vol. 79, November, 1144

False aneurysm of the abdominal aorta following pancreatectomy A . T . Edwards, D . J. DeFriend, R . K. Vohra and C. N. McCollum University Department of Surgery, University Hospital of South Manchester, Nell Lane, Manchester M20 BLR, UK Correspondence to: Mr A. T. Edwards

False aneurysms of the abdominal aorta are rare, usually follow trauma and often present years after the initial injury. Patients may be younger than the usual age for aortic aneurysms and the diagnosis is often overlooked, with an attendant risk of rupture. This paper describes a patient with a large false aneurysm that developed 10 years after distal pancreatectomy.

Case report A 61-year-old man was referred with a spontaneous left calf deep vein thrombosis ( D V T ) , which was confirmed by ascending venography. He was given anticoagulant therapy and underwent abdominal ultrasonography to exclude an occult malignancy. The scan demonstrated a saccular aneurysm of the upper abdominal aorta 5 cm in diameter. The patient had undergone distal pancreatectomy 10 years earlier for chronic alcohol-related pancreatitis. He smoked 20 cigarettes a day but had no symptoms of cardiovascular disease, although he was aware of an uncomfortable 'lump' in the epigastrium. The patient appeared healthy, was haemodynamically stable. and had a non-tender pulsatile mass in the epigastrium. All peripheral pulses were normal, with some residual tenderness and swelling of the left calf following DVT. Routine

full blood count and biochemical findings were normal, as were the results of chest radiography. A mass of 8 cm arising from the aorta anterior to the pancreatic bed and left renal vein was seen on computed tomography ( F i y u r e 1 ). The appearance was of a pseudoaneurysm. Angiography was performed to localize the origin from the aorta and to confirm that this was not an inflammatory mass adherent to the aorta. At operation a large false aneurysm arising from the front of the aorta below the level of the renal arteries was excised, and the resulting defect was repaired with a Dacron ( D u Pont. Stevenage, U K ) patch. Following a spontaneous cerebrovascular accident on the fourth day after surgery, recovery was complete, and the patient remains asymptomatic 6 months after operation.

Discussion The anterior aneurysm just below the renal vessels was probably caused by injury to the aorta during surgical dissection. The complication has not been reported previously, perhaps because most pancreatectomies are performed for malignancy in patients with poor life expectancy. Pseudoaneurysm of the abdominal aorta is rare and has previously always followed some form of abdominal trauma, which may explain why patients have been exclusively male'. The usual sequel to aortic injury is full-thickness disruption and fatal haemorrhage; however, the aortic wall in the young is more resilient to blunt trauma, so that laceration of the intima and media may be contained by the adventitia and result in a false aneurysm. Most cases follow penetrating trauma, with only 25 per cent occurring after blunt injury. Those following blunt trauma occur almost entirely in the distal aorta and at the aortic bifurcation'. The distribution of false aneurysms following penetrating trauma is more random, with the proximal abdominal aorta affected as often as the distal vessel3. The reported times to presentation range from 4 days to 27 years, but the majority present within 2 years of injury2. Most patients present with complications arising in the pseudoaneurysm, an abdominal mass associated with a bruit or symptoms of compression involving surrounding structures'. Aortocaval fistulation may occur in traumatic pseudoaneurysms4. Rupture does happen; six of 22 patients have died from this complication'. Most false aneurysms may be repaired with a simple patch, but occasionally suprarenal false aneurysms require extensive surgery, with reimplantation of the renal or visceral arteries.

References 1. 2. 3. 4.

Potts RG, Alguire PC. Pseudoaneurysm of the abdominal aorta: a case report and review of the literature. Am J Med Sci 1991; 301: 265-8. Edwards AT, Williams IM, Griffith G H . Blunt injury to the abdominal aorta. Injury 1990; 21: 408-9. Chaikof EL, Shamberger RC, Brewster DC. Traumatic pseudoaneurysm of the abdominal aorta. J Trauma 1985; 25: 169-73. Krishnasastry KV, Freidman SG, Deckoff SL, Doscher W. Traumatic juxtarenal aorto-caval fistula and pseudoaneurysm. Ann Vasc Surg 1990; 4: 378-80.

Paper accepted 25 April 1992



0 1992 Butterworth-Heinemann Ltd

False aneurysm of the abdominal aorta following pancreatectomy.

Case report Br. J. Surg. 1992, Vol. 79, November, 1144 False aneurysm of the abdominal aorta following pancreatectomy A . T . Edwards, D . J. DeFrien...
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