title: Staged endourologic and endovascular repair of an infrarenal inflammatory abdominal aortic aneurysm presenting with forniceal rupture.
abstract: We present the case of a 79-year-old female who presented with severe left flank pain and a pulsatile abdominal mass. She was diagnosed with left peripelvic urinary extravasation and forniceal rupture secondary to an intact infrarenal inflammatory abdominal aortic aneurysm with extensive periaortic fibrosis. Successful operative repair was performed with staged ureteral and endovascular stenting with subsequent resolution of periaortic inflammation and ureteral obstruction, and shrinkage of the aneurysm sac. Inflammatory abdominal aortic aneurysms (IAAAs) represent 5% to 10% of all abdominal aortic aneurysms. The distinguishing features of inflammatory aneurysms include thickening of aneurysm wall, retroperitoneal fibrosis, and adhesions to adjacent retroperitoneal structures. The most commonly involved adjacent structures are the duodenum, left renal vein, and ureter. Adhesions to the urinary system can cause hydronephrosis or hydroureter and result in obstructive uropathy. An unusual case of IAAA presenting with forniceal rupture is presented, with successful endovascular and endourologic repair.
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Edmonds
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Tomaszewski
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Jackman
authors.forename: Rabih A
authors.initials: RA
authors.lastname: Chaer
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D005260:Female; D021501:Flank Pain / Q000209:etiology / Q000601:surgery; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000601:surgery; D007674:Kidney Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D012185:Retroperitoneal Fibrosis; D012421:Rupture; D015607:Stents; D000267:Tissue Adhesions; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000295:instrumentation