[Acute abdominal and back pain in a patient with an aortic aneurysm and a duodenum perforation on CT-scan].
An 82-year old man with a known aneurysm of the abdominal aorta (AAA) presented with a history of acute onset abdominal and back pain of a few hours. He was haemodynamically stable and had pain on pressure over the aneurysm. Ultrasound confirmed the AAA, but could not demonstrate or exclude rupture. Subsequent CT-scan confirmed a non-ruptured AAA and demonstrated a small, curvilinear, hyperdense structure thought to be a fish bone or chicken bone which had perforated the duodenum. On gastroduodenoscopy, a fish bone was found and removed. The patient's symptoms resolved completely within two days. In patients with a possible ruptured AAA, echographic or CT-scan investigations can confirm or exclude the condition thus avoiding unnecessary surgery. These investigations also gather preoperative data for potential endovascular reconstruction. Before the introduction of new visualization techniques a duodenum perforation resulting from the unnoticed swallowing of a sharp object could only be diagnosed by explorative laparotomy. Delay in diagnosis leads to high mortality.
Puylaert
J B C M
JB
Afd. Radiologie, Medisch Centrum Haaglanden, locatie Westeinde, Lijnbaan 32, 2512 VA Den Haag. dr.jbcmpuylaert@wxs.nl
de Mol van Otterloo
J C A
JC
Meijssen
M A C
MA
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D001019:Aortic Rupture / Q000000981:diagnostic imaging; D001416:Back Pain / Q000209:etiology; D003937:Diagnosis, Differential; D004378:Duodenal Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D004386:Duodenum / Q000293:injuries; D005547:Foreign Bodies / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D014057:Tomography, X-Ray Computed / Q000379:methods*