Abdominal Aortic Aneurysm

In August 2023, I was given the chance for an exchange program by the Standing Committee on Professional Exchange Center for Indonesian Medical Student Activities (SCOPE CIMSA) in Messina, Sicily. I was assigned to the Anesthesiology department and I had the chance to see several cases, one of them was a patient that had abdominal aortic aneurysm.

An abdominal aneurysm, specifically an abdominal aortic aneurysm (AAA), is a serious medical condition characterized by the abnormal dilation of the aorta within the abdominal region. The aorta, the body’s main artery responsible for carrying oxygen-rich blood from the heart to the rest of the body, weakens in a specific section, leading to enlargement and potential rupture, causing severe internal bleeding. Typically, abdominal aortic aneurysms develop gradually and remain asymptomatic in their early stages, making them a hidden yet potentially life-threatening threat (Shaw et al., 2023). Understanding abdominal aneurysms is critical because untreated cases can have catastrophic consequences. Early detection through medical imaging and knowledge of risk factors are crucial for effective treatment and prevention of fatal complications. This introduction provides a foundation for discussing the causes, risk factors, symptoms, diagnosis, and treatment options for abdominal aneurysms, emphasizing the importance of preventive healthcare and screening for at-risk individuals.

The patient was a 60-year-old male presented with worsening back pain and was referred to the vascular clinic due to the incidental discovery of an abdominal aortic aneurysm during imaging conducted to assess his back pain. He had been experiencing low back pain for several years, with a significant worsening of symptoms just over two months ago. His medical history included a previous episode of painless hematuria that revealed a 4-cm infrarenal AAA without inflammatory changes. Family history indicated an AAA in his mother, and he had a significant history of smoking and hyperlipidemia managed with simvastatin. Additionally, he used ibuprofen as needed for pain relief and had responded positively to brief courses of tapering steroids prescribed by his healthcare provider.

Physical examination revealed a 1.4 cm thick soft tissue inflammatory rind and an infrarenal AAA measuring approximately 4.2 x 3.9 cm², as identified through CT angiography. Laboratory examinations showed normal erythrocyte sedimentation rate, creatinine, and complete blood count, but an elevated CRP level. IgG4 levels were within normal range during immunoglobulin subclass testing, and serologies for various antibodies came out negative. Treatment options included corticosteroids or other anti-inflammatory and immunosuppressive therapies for patients with symptomatic infrarenal AAAs when surgical repair was not warranted.

By: Jovan Ferrel Reynaldo Siswanto, FK UNAIR