A Case of Chronic Contained Rupture of Abdominal Aortic Aneurysm Resulting from Spinal Caries / 日本心臓血管外科学会雑誌

ABSTRACT

We report a case of a chronic contained rupture of abdominal aortic aneurysm associated with spinal caries. A giant retroperitoneal mass with bony destruction of the anterior bodies of thoracic and lumber vertebrae was detected on computed tomography in a 72-year-old woman. The patient was asymptomatic but had a history of spinal tuberculosis complicated with cold abcess 44 years earlier. Magnetic resonance imaging suggested the presence of a paravertebral retroperitoneal abscess or organized hematoma. Surgery was performed through median laparotomy and an aortotomy revealed a punched-out defect, 17mm×17mm in size, in the posterior wall of the abdominal aorta, and the large cavity of an aneurysm with an organized thrombus was observed through the defect. The abdominal aorta and common iliac arteries were replaced with a bifurcated graft. The punched-out defect was closed with the anterior wall of the aorta for the purpose of isolating the prosthesis from the aneurysm. The postoperative course was uneventful and there were no signs of prolonged inflammatory reactions. In this case, it was considered that chronic contained rupture of the abdominal aortic aneurysm resulted from spinal tuberculous osteomyelitis eroding into the aorta.