CLINICAL REPORTS   

Chirurgia 2002 February;15(1):43-6

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: Italian

Rupture of a giant isolates aneurysm of the common iliac artery. Unusual clinical presentation and management

Irace L., Siani A., Jabbour J., Gattuso R., Dionisi C., Tozzi M., Gabrielli R.

An 82-year-old man was hospitalized in the emergency department of our hospital, with clinical symptoms of weak pain in the left iliac fossa and in the upper segment of the lower limb with paralysis of the abduction and flexion movements of the thigh on the pelvis. The clinical examination highlights a beating mass in the left iliac fossa, simulating an aorta-iliac aneurysm. The neurological examination shows loss of the knee and ankle reflex, with deficit of the flexion and abduction of the thigh without any impairment of the sensitivity. The patient was hemodynamically stable. The duplex-scanning showed the presence of a 12 cm left common iliac artery aneurysm; CT scan confirmed its presence with a retroperitoneal hematoma. The patient was immediately transferred to the operating room, where a median xifo-pubic laparotomy was carried out. The sudden hemodynamic instability suggested a subdiaphragmatic aortic clamping. After dissection of the hematoma, the clamp was placed on the subrenal aortic segment and an aorto-bisiliac bypass was carried out. The postoperative course was without complications. The isolated aneurysms of the iliac artery are much less frequent than the abdominal aneurysm. Their incidence is of 0.03% rapresenting 0.9-2.2% of the aneurysmatic pathology of the abdominal vessels. The natural evolution of the aneurysm, the diagnosis and surgical treatment are discussed.