Inflammatory aneurysms of the abdominal aorta.

Abstract

Unexpected anatomical or pathological variants can create technical problems which increase the usually low surgical morbidity and mortality rates of abdominal aortic aneurysms. One such variant is inJIammatory aneurysm, so-called because of the densejbrosis which characteristically envelopes the aortic wall and adjacent viscera. Ten such cases are described. Although inzammatory aneurysms were larger (average diameter, IO. 0 cm vs. 7.8 cm) and more often symptomatic (80% vs. 31%), there were no clinical or laboratory data which, before operation, could distingui?h them from ordinary atherosclerotic aneurysms. However, each had a characteristic gross appearance-an unusually thick wall with a d@se, shiny, white fibrotic reaction in the retroperitoneum that was continuous with the aortic wall. The fourth portion of the duodenum invariably was incorporated into the inJlammatory mass which in some cases also involved the sigmoid colon, small bowel, or ureter. Four of the IO patients were operated on emergent& because of severe abdominal pain, but or+ one had in fact ruptured. The single ,death was due to sepsis porn duodenal breakdown. Blood replacement averaged 8.2 units as compared with 4.7 units for other abdominal aneurysms. Pathologicc$ examination of the aortic wall revealed atherosclerosis with markedjbrous thickening and active chronic injammation of the media and adventitia. These 10 cases represent an uncommon but distinct pathological entity whose sigm$cance is that it can be identified at operation by its characteristic gross appearance. Once recognized, the initial operative maneuvers of aneurysmorrhaphy should be modified in that no e$ort should be made to mobilize the adherent duodenum from the aorta.