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(BQ) Part 2 book "100 cases in surgery" presents the following contents: Vascular, urology, orthopaedic, ear, nose and throat, neurosurgery, anaesthesia, postoperative complications. Invite you to consult. | VASCULAR CASE 42 A PULSATILE MASS IN THE ABDOMEN History A 68-year-old man presents to the emergency department with a 1-h history of pain in the left side of his abdomen. The pain started suddenly while he was getting up from a chair. It became constant and radiated through to his back. His past medical history includes hypertension and stable angina. He lives with his wife and is normally independent. Examination The patient is pale sweaty and clammy. His pulse is 100 min and the blood pressure is 90 50 mmHg. Heart sounds are normal and the chest is clear. Examination of the abdomen reveals a large tender mass in the epigastrium. The mass is both pulsatile and expansile. The peripheral pulses are present and equal on both sides. There is no neurological deficit. ỵP INVESTIGATIONS Haemoglobin 9.3 g dL Normal 11.5-16.0 g dL Mean cell volume White cell count Platelets Sodium Potassium Urea Creatinine 86 fL 5 X 109 L 250 X 109 L 143 mmol L 4.4 mmol L 4.2 mmol L 72 pmol L 76-96fL 4.0-11.0 X 109 L 150-400 X 109 L 135-145 mmol L 3.5- 5.0 mmol L 2.5- Ó.7 mmol L 44-80 pmol L C-reactive protein CRP 20 mg L 5 mg L Amylase 22 lU dL 0-100 lU dL Questions What is the most likely diagnosis What is required in the immediate management of this patient What is the prognosis 97 100 Cases in Surgery ANSWER 42 The most likely diagnosis is a ruptured abdominal aortic aneurysm. An aortic aneurysm is defined as an increase in aortic diameter by greater than 50 per cent of normal 3 cm . The aneurysm diameter can increase exponentially by approximately 10 per cent per year. As the aneurysm expands so does the risk of rupture Aneurysm size 5.0-5.9 cm approximately 25 per cent 5-year risk of rupture 6.0-6.9 cm approximately 35 per cent 5-year risk of rupture More than 7 cm approximately 75 per cent 5-year risk of rupture Aneurysm rupture Figure 42.1 can present with abdominal pain radiating to the back groin or iliac fossae. An expansile mass is not always detectable and other conditions .
