Abstract
Recently the entity of penetrating atherosclerotic ulcer (PAU) had been apparent. We had encountered a very rare case with periaortic multi-nodular lesions caused by repeated rupture due to PAU. A 61 year-old female patient visited us because of her back pain. Routine computed tomography demonstrated a giant abdominal aneurysm and many tumor-like lesions at periaortic area that were considered for metastatic lymphnodes before surgery. Although preoperative diagnosis was not so accurate, surgical treatment was performed 16 June 2000 because of the high risk of rupture. Laparotomy revealed the giant abdominal aneurysm, 9 cm in diameter, with thicken, uneven wall adhering to adjacent tissue such as retroperitoneal membrane and soft tissues.Surgical process is not so smooth but successful. There were many diverse ulcers and intramural hematomas in abdominal aortic aneurysm. Ulcers made several pseudoaneurysms looking like bunch of grapes.The patient underwent successfully extended polytetarafuroroethylene grafting and postoperative course was uneventful. Eight years later computed tomograhy depicted no sign of recurrence. We concluded that aggressive surgical treatment for PAU of infrarenal abdominal aneurysm should be performed because of avoiding a life-threatening rupture of aneurysm.
