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01 July 1999

Abdominal aortic aneurysm and concomitant intra-abdominal malignancy diagnostic and therapeutic problems

Stanisław Molski, Michał Szpinda, Anna Grabowska-Gaweł, Jarosław Jaroszek, Zygmunt Mackiewicz

Med Sci Monit 1999; 5(4): CR703-708 :: ID: 503493

Abstract

Coexistence of the aortic abdominal aneurysm (AAA) with intra-abdominal malignancy (IAM) is not a rare phenomenon. It poses a challenge for the surgeon both from diagnostic and therapeutic standpoints. In our study we discuss 5 cases of coexistent AAA and IAM out of 218 patients admitted to the hospital between January 1993 and June 1997 for the aneurysm surgery. In all cases patients had been qualified for surgical procedure because of AAA (aneurysm ranged from 4.6 to 5.5 cm), and the neoplasm had not been diagnosed prior to the operation. Abdominal malignancies included: gastric cancer - 1, pancreas cancer - 1, retroperitoneal space leiomyosarcoma - 1, colon cancer - 1, and one disseminated malignant process with not established primary focus. Aortic reconstruction was carried out in four cases. Among them simultaneous operation was performed in one case concomitant AAA and leiomyosarcoma of peritoneal space using transperitoneal approach. Two-stage procedure underwent patient having colon cancer. In remaining two cases, however, the malignancy was not revealed during the aortic reconstruction. In one case aneurysm was not resected because of the disseminated gastric cancer which had been revealed at the time of laparotomy. All patients died of the metastatic disease complications. The patient who survived the longest was woman treated simultaneously for AAA and IAM. The progression of colon cancer precluded radical surgery of the another patient at the second stage. The treatment of AAA coexistent with IAM should be determined by the size of aneurysm, the type of malignancy, its location and stage of development. The operator should take into account both the risk of aneurysm rupture and the progression of neoplasm the latter of which may make impossible radical management in the future. One cannot overemphasis the importance of meticulous exploration of the abdominal cavity when using transperitoneal approach for aortic reconstruction.

Keywords: treatment, Diagnosis, abdominal malignancy, aortic aneurysm

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