The Red Balloon: Case of a 60-Year-Old Male With Giant Abdominal Aortic Aneurysm - A Case Report

Abdominal aortic aneurysm (AAA) causes 170,000 deaths worldwide. In the Philippines, 100,000 estimated number of Filipinos have aortic aneurysm at any given time. AAA is defined as dilatation of a wall of more than 3 cm in diameter at any segment or a diameter greater than or equal to 1.5x of the aortic diameter at the level of the diaphragm. Giant abdominal aneurysm is defined as aneurysm with a diameter of more than 10 to 13 cm in the maximum transverse diameter. Several risk factors were identified such as hypercholesterolemia, advanced age, male sex, hypertension, smoking, family history and connective tissue disease. The prevalence of rupture annually of giant abdominal aneurysm was 30%-50% and this required surgical repair. We report the case of a 60-year-old Filipino male, a known hypertensive and chronic smoker with no family history of aneurysm and connective tissue disease who presented with a visible pulsatile mass on the hypogastric region and associated with left lower quadrant pain radiating into the back. Upon admission a CT aortogram was done and revealed giant infrarenal fusiform aneurysm measuring 11.6 cm x 9.4 cm x 16.9 cm (T x AP x L) with dilatation of the proximal bilateral common iliac arteries, each measuring 2.6 cm in diameter. Open surgical approach was the best option of treatment over endovascular repair (EVAR) to the patient due to unfavorable neck anatomy of the infrarenal aneurysm that may greatly affect device delivery. The patient underwent exploratory laparotomy with endoaneurysmorrhaphy and bifurcated graft aortoiliac anastomosis with intraoperative findings of 12 cm in transverse diameter of fusiform infrarenal aneurysm extending to bilateral common iliac arteries. The patient improved and was discharged after 10 days. We highlight the significance of giant aneurysms with prevalence of 0.03%. It is still unknown the exact mechanism of giant abdominal aneurysm which have reached this size and remain unruptured. Keywords: Abdominal aortic aneurysm; giant abdominal aortic aneurysm; endoaneurysmorrhaphy; endovascular repair of abdominal aortic aneurysm (EVAR)