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.