A 62-year-old woman with a history of hypertension, type 2 diabetes mellitus and COPD secondary to smoking consulted at her home hospital for two days of evolution of severe abdominal pain associated with vomiting.
We performed an ultrasound study and computed tomography (CT) that showed an abdominal aortic aneurysm (diameter 5.6 cm) and an uncomplicated UPAA, so it was referred to our hospital.
He was admitted to our center and was ruled out that the pain was secondary to a complication of the abdominal aneurysm, an abdominal ultrasound was performed suggesting an infectious process in the right iliac fossa.
With the background gathered, it was catalogued as acute abdomen and a laparotomy was carried out finding tiflanasitis and intestinal necrosis, so it was decided to perform a resection and ileotomosis.
Subsequently, due to the time elapsed, a new CTA was performed, which showed UPAA, with contrast passage extending beyond the aortic wall, without symptoms of AAS.
Preoperative coronary angiography showed no significant lesions and echocardiography showed left ventricular hypertrophy, type II diastolic dysfunction and dilatation of the left atrium.
Due to the high risk represented by the UPAA, surgery was decided, which was performed 5 weeks after abdominal surgery.
Pathological endoscopy was performed under cardiopulmonary bypass replacement with GelwareTM#26.
A pulsatile lesion of about two centimeters in diameter was observed in the anterior surface of the AA. At dissection of the AA, three ulcers were found, one of them at a right coronary dissection centimeter from the ost.
The aorta was preserved and the patient was discharged seven days after surgery, differing the resolution of the abdominal aneurysm.
The pathological study confirmed UPAA.
Currently, at one year and ten months of follow-up, the patient continues her controls in Cardiology without presenting cardiovascular symptoms.
