Discussion:
Giant aneurysm of the aorta is defined as an aneurysm with a diameter of more than 10 cm. In general population, occurrence of giant aneurysm is not prevalent. On the other hand, presence of one of the giant aneurysm etiologies including connective tissue disorder such as Marfan and Ehlers-Danlos syndromes, infection with syphilis, tuberculosis and HIV, atherosclerotic vascular diseases, and giant cell arthritis make the formation and progress of giant aneurysms more probable. Aneurysms can be completely asymptomatic and discovered accidentally. However, giant aneurysms can cause nonspecific symptoms due to their compression effect in to the surrounding organs. Moreover, the symptoms of some aortic aneurysm cases appear when they rupture or are dissected suddenly. The risk of rupture of the aneurysm is directly affected by the size of the aneurysm. The probability of rupture in aneurysms with diameters of equal or greater than 8 cm is almost 40%.[1, 4]Rupture of aneurysm has a spectrum ranging from contained rupture to flank rupture of aneurysm which can empty the patient’s cardiovascular capacity in few minutes. TAAA can be repaired by endovascular or open aortic construction approaches. However, in ruptured cases, open surgery is a definite option for the survival of the patient.
For a thorough examination and making a correct diagnosis, computed tomography scan with contrast and CTA have necessary specificity and sensitivity for detecting detailed information about mural thrombus, hematoma, aneurysm wall, leakage, or rupture of aneurysm.[3, 5]
In the present case, we encountered a giant chronic TAAA with contained leak which led to formation of circumferential mural thrombus in addition to an acute frank rupture of aneurysm within the thrombus. This case presented with upper gastrointestinal obstruction manifestation and was managed with resuscitation and an emergency aorto-renal reconstructive surgery.