Saving the life of a patient with a ruptured aortic aneurysm

(Baonghean.vn) -With advanced techniques in aortic surgery,Patient Vi Ngoc Hinh (Quy Hop, Nghe An)miraculously saved

Today, patient Vi Ngoc Hinh, 47 years old, residing in Quy Hop, treated at the Department of Thoracic Surgery (Nghe An General Hospital) was discharged from the hospital. The patient suffered from a very rare disease: rupture of the aortic iliac pseudoaneurysm caused by Whitmore bacteria, causing abscess and vascular necrosis. With advanced techniques of artificial axillary-femoral and femoral-femoral artery bypass grafting, the patient was miraculously saved by the doctor.

Previously, in early July, the patient had severe abdominal pain, writhing; severe pain in the left iliac fossa and lower back, high fever of nearly 40 degrees, and persistent chills that did not subside. The excruciating and persistent pain made the patient unable to walk, eat, and was accompanied by insomnia, leading to weight loss and exhaustion. Despite treatment at the district-level medical facility, the patient's condition did not improve. On July 31, the patient was transferred to Nghe An General Hospital.

Upon admission, the patient was ordered by the doctor to undergo an antibiotic test to determine the cause of the prolonged fever. Through examination, the doctor discovered a pulsating aneurysm in the left iliac fossa. At the same time, ultrasound and CT scan images determined that the left common iliac artery had ruptured into the retroperitoneal cavity, forming a pseudoaneurysm measuring 38x40mm.

Life-saving surgery for a patient with a ruptured aortic iliac pseudoaneurysm. Photo: Hoang Yen

The consultation between the Board of Directors and related departments reached the final diagnosis: the patient was infected with the Gram-negative bacillus Burkholderia Pseudomallei (Whitmore's disease). The bacillus attacked the aortic aneurysm, causing infection, thereby perforating the vessel and creating a pseudoaneurysm of the left iliac aorta.

The patient's prognosis is very serious. Although the hospital's Board of Directors directly advised him to transfer to a higher level, the patient's family still insisted on staying at Nghe An General Hospital for treatment.

Determined to save the patient by all means and not let down the family's trust, the departments of Thoracic Surgery, Anesthesia, Laboratory, and Clinical Pharmacy carefully consulted the case and decided to perform surgery to save the patient. At the same time, Nghe An General Hospital contacted leading vascular surgery experts from Bach Mai Hospital and Viet Duc Hospital to receive advice on the appropriate surgical plan and timing.

On July 4, the patient underwent major surgery. The patient was transferred to emergency surgery to save his life.

“In the patient’s abdomen, there was a lot of thin blood flowing from the ruptured aneurysm. The left main iliac artery aneurysm was very large, occupying the entire lower half of the abdomen. We quickly found and ligated the abdominal aorta below the kidney as high as possible, and simultaneously ligated the iliac arteries on both sides to isolate the infected mass. The ruptured left main iliac artery aneurysm was opened, the surgical team removed all necrotic tissue and placed 3 drainage tubes.

The most difficult thing about this surgery is that we cannot replace the Y-shaped artificial vessel like other patients with ruptured abdominal-iliac aortic aneurysms, because the risk of the anastomosis bursting and the patient dying is very high. Therefore, we chose to perform a artificial vessel running in a tunnel just under the skin, connecting directly from the axillary artery to the left femoral artery; and from the left femoral artery to the right thigh.

This extra-anatomical bridge is only used in cases of extreme emergency. And fortunately, as soon as the artificial axillary-femoral and femoral-femoral blood vessels were bypassed, the patient's peripheral blood circulation was restored well. During the surgery, the surgical team transfused 3 liters of blood and blood products to the patient," said Master, Doctor Pham Van Chung - Deputy Head of Thoracic Surgery Department.

Patient Vi Ngoc Hinh was discharged from the hospital today but will continue to take anticoagulants and be closely monitored. Photo: Hoang Yen

After surgery, the patient was closely monitored in the Surgical Intensive Care Unit before being transferred to the Thoracic Surgery Department for treatment. Immediately after surgery, the patient's prolonged high fever was controlled; the patient's health was stable and he was able to eat.

With the advice of Clinical Pharmacy, the patient continued to use high doses of antibiotics to treat Whitmore. At the same time, "The patient was discharged from the hospital today but continued to use anticoagulants and was closely monitored" - Dr. Chung added.

Hoang Yen