A Case of Inflammatory Abdominal Aortic Aneurysm Whose Persistent Postoperative High Fever Was Successfully Treated by Steroid

(Department of Surgery, Mito Red Cross Hospital, Mito, Japan and Department of Cardiovascular Surgery, Ashikaga Red Cross Hospital*, Tochigi, Japan)
Norio Uchida Masataka Yamazaki*
The indications of steroid therapy for inflammatory abdominal aortic aneurysm (IAAA) is controversial. We here report a rare case whose persistent postoperative high fever and duodenal obstruction due to adhesion to the residual aortic wall were successfully treated by steroid. A 73-year-old man was referred to our hospital because of abdominal pain and a pulsating mass in his umbilical region. CT scan showed a remarkably dilated infrarenal abdominal aorta (10cm in diameter) with a mantle sign. Preoperatively C-reactive protein (CRP) was high, however temperature was normal. We replaced the aneurysm with a bifurcated prosthetic graft (18×9mm collagen impregnated knitted Dacron) by laparotomy on April 10, 2001. The aneurysm showed a thick and fibrous surface tightly adhering to the jejunum, sigmoid colon and ureters. We tried to minimize surgical injury to perianeurysmal fibrotic tissue. However the right ureter was injured and repaired using a double-J catheter. Histopathological examination revealed lymphoplasmocystic infiltration in the wall of the aorta, which was compatible with IAAA. From the 10th postoperative day high fever (38 to 39℃) persisted and CT revealed perigraft seroma with air density. Graft infection was suspected and the perigraft fluid was drained by puncture. However cultures of the serous fluid was negative. Moreover, approximately 1,500ml gastric juice was drained per day via a nasogastric tube. Therefore we suspected postoperative inflammatory reactions to the impregnated Dacron graft and/or inflammation of the residual aortic wall. This patient was given 20mg prednisolone intravenously 18 days after the operation and the dose of steroid was then tapered. This therapy had an obvious effect on the recovery of the general condition. Body temperature and CRP was normal when he was discharged 46 days after surgery. The patient had no complaints and the thickness of the residual aortic wall around the graft was found to have decreased one year after the operation on follow up CT.
　Jpn. J. Cardiovasc. Surg. 32：132 -136 (2003)