Huge ticking time bomb in stomach: Rupture averted by timely repair

“Gigantic 20-cm abdominal aortic aneurysm repaired successfully”

New Delhi, July 01, 2019:

A team of doctors from Institute of Vascular and Endovascular Sciences, Sir Ganga Ram Hospital, recently, performed a complex surgery on a 30 yrs old male in whose stomach the main aorta (artery) had swelled to gigantic size of 20 cms (normal size is 17 to 18 mm). It was like a huge balloon filled with blood which could burst any time and prove fatal. The very high risk operation was subsequently carried out by Dr. V.S. Bedi and team which lasted for 4 hours and the life of patient was saved.
Abdominal aortic aneurysm (ballooning of main artery) is a significant source of morbidity above 50 years. Size confers the largest risk factor for aneurysm rupture, with aneurysm size more than 6 cm having an annual rupture risk of 14.1 %. Giant abdominal aortic aneurysms (AAA), defined as more than 11cm, are rarely described in literature.
*According to Dr. V.S. Bedi, Chairman, Institute of Vascular And Endovascular Sciences, Sir Ganga Ram Hospital, “We believe this case represents one of the large AAAs in the literature and demonstrates the feasible approach for successful open repair. We were surprised to see this kind of large aneurysm in a 30 year old person as we see this kind of disease in 60-70 years age bracket commonly.”*
A 30 year old male presented to SGRH with a history of suddenly enlarging abdominal lump associated with unrelenting pain in the right flank which was diagnosed as a large (20cm diameter) abdominal aortic aneurysm with contained leakage of blood from a focal rupture site. The patient had consulted doctors at outside hospitals for its surgical treatment but was told that the surgery would entail prohibitive risk to life of the patient given the magnitude of the disease and size of the aneurysm.

The patient was subsequently admitted in high dependency unit of Institute of Vascular And Endovascular Sciences, Sir Ganga Ram Hospital under care of the unit head, Dr. V.S. Bedi and his team. Monitored high dependency intensive care was administered to the patient preoperatively in order to render him fit for the upcoming perilous surgical undertaking which was carried out on the 17th of June 2019 in the newly built, state of the art hybrid vascular Cath lab.

The surgery of aneurysm was preceded by a diagnostic angiogram which demonstrated the large infrarenal (below the kidney arteries) abdominal aortic aneurysm. The very high risk operation was subsequently carried out by Dr Bedi and team which lasted for 4 hours during which the aneurysm sac was meticulously opened under control and blood flow was restored with the help of vascular graft. During the surgery almost one litre (two kidney trays) of blood clots was removed which left a huge cavity in the sac. The anesthesia and complex perioperative hemodynamic changes during surgery were adeptly managed by Dr. K.K. Narani and team from department of anesthesia, SGRH. This ensured complete stability and safety of the patient throughout the otherwise hazardous procedure.

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On completion of surgery, the patient was shifted to postoperative ICU where he was extubated on following day after which he resumed normal body functions like eating, walking and sleeping without pain in a span of only two days. The patient eventually was shifted out of ICU on the third postoperative day in a stable condition.

It is worth noting that aneurysms of these dimensions are rarely encountered in young patients such as this one. The Institute of Vascular And Endovascular Sciences, SGRH has a considerable surgical experience involving abdominal aortic aneurysms where even difficult cases have been managed with team effort. The patient, after being given a new lease of life happily celebrated his birthday by cutting a cake with vascular surgery team in the hospital a day prior to his discharge on the 7th post-operative day after making a full and speedy recovery.

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