A Case of Ruptured Abdominal Aortic Aneurysm Associated with Postoperative Paraplegia

(Department of Cardiovascular Surgery, Nagano Red Cross Hospital, Nagano, Japan)

Masayuki Sakaguchi Naobumi Fujii Kazunori Nishimura
Nobuyuki Yanagiya
A 72-year-old woman complaining of lumbago was transferred to our hospital in a state of shock. An admission abdominal CT scan showed infrarenal aortic aneurysm reaching 8cm in maximal diameter and hematoma of the retroperitoneal space. A clinical diagnosis of ruptured abdominal aortic aneurysm was rapidly established. An emergency operation was performed under general anesthesia. Laparotomy disclosed an infrarenal abdominal aortic aneurysm and hematoma. The aorta was clamped just below the bilateral renal arteries. Straight graft replacement was performed. There was enough heparinization during the surgical procedure. Postoperative findings involved paraplegia and hypoesthesia from dermatome Th10 with associated urinary and fecal incontinence. The patient was discharged from our hospital. Spinal cord ischemia is a rare and unpredictable complication in surgery of infrarenal abdominal aortic aneurysms. Presence of intra- and postoperative episodes of hypotension and the duration of the crossclamping seem to have been the most important factors for spinal cord ischemia in this case.
@Jpn. J. Cardiovasc. Surg. 30: 146-148 (2001)