Well another “jonah” call and a busy week!

Imagine this, on a quiet Sunday, I am on call. It was quiet till about 10pm, I get a call from my medical officer.
” A 60 year old man complained of left back pain around the loin. It was a sudden sharp continuous pain. He then told his son to massage his back. It helped a little. He said goodbye to his son who had to go for work. He went to toilet and thereafter asked his grand-daughter to massage him. As her massage was soft, he requested her to step on his back. This made his pain worse and he fainted and became unresponsive. He was brought in immediately and was initially confused but then collapsed and was resuscitated. Now, he is intubated with a heart rate of 100 and a blood pressure of 90/60 on two inotropes(drugs to maintain blood pressure).His abdomen is very distended, and he was very pale.”

With that, I made a diagnosis of ruptured Abdominal Aortic Aneurysm (AAA). We discussed with the family and they decided to give it a go for surgery.

What is an Aneurysm?

An aneurysm is when a blood vessel becomes abnormally large or balloons outward.

What causes an abdominal aortic aneurysm?

Atherosclerosis (also called hardening of the arteries).In atherosclerosis fatty deposits, called plaque, build up in an artery. Over time, this buildup causes the artery to narrow, stiffen and possibly weaken.

Risk factors that contribute to atherosclerosis, such as high blood pressure (hypertension). Besides atherosclerosis, other factors that can increase your risk of AAA include:
• Being a man older than 60 years
• Having an immediate relative, such as a mother or brother, who has had AAA
• Having high blood pressure
• Smoking

Risk of developing AAA increases as you age. AAA is more common in men than in women.

Signs & Symptoms

The symptoms of rupture include:

* Pulsating sensation in the abdomen
* Pain in the abdomen or back — severe, sudden, persistent, or constant. The pain may radiate to groin, buttocks, or legs.
* Abdominal rigidity
* Anxiety
* Nausea and vomiting
* Clammy skin
* Rapid heart rate when rising to a standing position
* Shock
* Abdominal mass

Findings from a few studies have suggested that most AAAs rupture into the left retroperitoneum. The retroperitoneum contains the leak by means of mechanisms that cause clotting or tamponade. This rupture can also cause abdominal, back, or flank pain; this symptom is related to impingement of the hematoma on adjacent structures.

Management

Surgery is recommended for patients with aneurysms bigger than 5.5 cm in diameter and aneurysms that rapidly increase in size. The goal is to perform surgery before complications or symptoms develop.

Prognosis

The outcome is usually good if an experienced surgeon repairs the aneurysm before it ruptures.

The mortality rate for ruptured AAA is substantial. As many as 2 of 3 patients with ruptured AAA die before arriving at the hospital. Of those who reach the hospital, as many as one fifth of those who die do so before the operation, and the overall mortality rate still averages approximately 49%.