A Case of Acute Type B Aortic Dissection in the Presence of Coexisting Chronic Fusiform Abdominal Aortic Aneurysm

Abstract

We report rare case of aortic dissection with coexisting chronic fusiform abdominal aortic aneurysm. The patient presented with unbearable back pain of sudden onset, followed by intolerable ischemic pain in the right lower limb. Contrasted computer tomography detected an acute type B dissection and the enlarged maximum diameter of the abdominal aneurysm of 45 mm. The arterial blood supply of the right limb was extremely compromised due to the enlarged false lumen, which impaired the circulation. Aortic replacement with distal anastomoses with the right common femoral and left common iliac artery was performed, after partial resection of an intimal flap in the abdominal aorta, creating re-entry of the false lumen. However, the hemodynamics of the patient remained unstable until the resection of the ileum and total colectomy, because of the bowel necrosis caused by concomitant dissection in the superior mesenteric artery. The case has been forced to receive intra-venous hyper-alimentation on an outpatient basis. This experience suggested the importance of appropriate surgical treatment followed by prompt and accurate diagnosis, and that caution should be exercised about the rare but serious condition of splanchnic ischemia under these circumstances.