Definition

James reported in 1935 on a patient dying of uraemia secondary to obstruction of both ureters in an inflammatory reaction around a large abdominal aortic aneurysm [27]. In 1955, DeWeerd et al. treated a patient with bilateral ureteral obstruction, severe hydronephrosis and a large abdominal aortic aneurysm [14]. The aneurysm was left alone and the ureteral obstruction was handled by bilateral nephrostomy followed by bilateral ureterolysis. They reported good renal function and patient survival at 15 months postoperatively. A few months later, Shumacker and Garrett [44] managed a similar patient by combined aneurysm replacement and ureterolysis. The patient had a 10-cm aortic aneurysm involving both common iliac arteries, which was replaced by a bifurcation graft. At operation, they found that the jejunum and sigmoid colon was firmly adherent to a thick inflammatory mass that surrounded the aneurysm. The patient's renal function improved markedly after the operation and an intravenous pyelogram (IVP) at 2 months was normal. In 1972, Walker et al. [59] presented a landmark paper where they described their experience in 19 patients with this kind of disease, representing 10% of their total series of abdominal aortic aneurysms. Rupture was noted in three patients and the overall operative mortality rate was 19%. They emphasized the hazards of separating adjacent retroperi-toneal structures from their surfaces and were the first to coin the term "inflammatory aneurysm". This historical paper was soon followed by numerous other observations [19, 37, 43]. Therefore, inflammatory abdominal aneurysm emerged as a distinct clinical and pathological entity describing these aneurysms characterized by a very thick wall as they are encased by an excessive, whitish hard fibrotic inflammatory mass ("porcelain aneurysm"), creating dense adhesions to adjacent structures and eventually involving the ureters and/or the caval vein (Figs. 5.3.1, 5.3.2).

Fig. 5.3.1 Operative view demonstrating inflammatory aneurysm (porcelain aneurysm) with dense adhesions to the duodenum
Fig. 5.3.2 Operative view after incision of inflammatory aneurysm. Note the 15-mm-thick aortic wall (arrow)

Was this article helpful?

0 0
Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

Get My Free Ebook


Post a comment