A 62-year-old man was operated for inflammatory abdominal aortic aneurysm through a median transperitoneal approach and was discharged. He returned 3 months later with signs of graft infection. He was re-explored through a left retroperitoneal approach, the remnant of previously left aneurysmal wall was resected as much as possible with extended debridement of necrotic tissues. The wound was thoroughly irrigated, then packed by sponges soaked with 10% iodine solution. This maneuver was repeated 6 times every 8 hours. After 48 hours, the left dorsal latissimus muscle was removed with the attachment of vascular pedicles and transpositioned to the retroperitoneal space around the graft. Vascular anastomoses were made to the inferior epigastric artery and vein. The wound was closed but drainage tubes were left in place. Although prolonged periods were required for the complete healing, he was eventually discharged with “in-situ” preservation of the original graft with no infectious signs. The recurrence of infection was not observed and he is doing well at over 5 years.
A 73-year-old man consulted our cardiology department for hypertension and post-myocardial infarction angina pectoris. After the examination, early gastric cancer was discovered at the lower gastric confines. Preoperative examination (abdominal CT scan) revealed an abdominal aortic aneurysm 7 cm in diameter and a left renal tumor. Simultaneous nephrectomy and repair of the abdominal aortic aneurysm were performed with a median retroperitoneal approach. Immediately after the operation, the white blood cell count increased transiently. At that time, the level of granulocyte colony stimulating factor (G-CSF) in the blood was high (81 pg/ml). The histopathological diagnosis of the tumor was renal cell carcinoma and immunohistochemical staining with an anti G-CSF antibody demonstrated cancer cells producing G-CSF. The postoperative course was uneventful. The patient underwent endoscopic resection of the gastric cancer 38 days after the first operation.