Transfused 2.1 liters of blood, successful surgery saves patient with abdominal aortic aneurysm and rupture

Early morning of June 6, the Emergency Department of Nghe An General Hospital received a serious patient, Mr. Nguyen Xuan Hai (born in 1938, living in My Thien hamlet, Nam Cat commune, Nam Dan district). According to the family's declaration: Mr. Hai is an elderly man living alone, without wife or children. At 9:00 p.m. on June 5, Mr. Hai suddenly had severe abdominal pain. And at 2:00 a.m. the next morning, the children living nearby learned of his condition and took him to the hospital.

Patient Nguyen Xuan Hai was admitted to the hospital in a state of hemorrhagic shock, lethargic, pale skin, pale face, distended abdomen, severe abdominal pain, and low blood pressure. The Emergency Department of Nghe An General Hospital quickly performed blood tests and bedside ultrasound and discovered a ruptured aneurysm in the abdominal aorta, with a large amount of retroperitoneal hematoma. The department performed resuscitation, consulted with related departments, and transferred him to emergency surgery.

The emergency surgery for patient Nguyen Xuan Hai lasted from 4:30 a.m. to 8:00 a.m. on June 6 to be completed. The hospital's surgical team encountered certain difficulties when performing the emergency surgery for the patient: The abdominal aortic aneurysm was very large, 10 cm x 12 cm (in a normal person, the diameter of the aorta is less than 2 cm); the abdominal aorta ruptured, causing massive bleeding and accumulation in the abdominal cavity; there was no more anatomical damage - the surgeons could not find the boundary of the aneurysm.

The patient's abdominal aorta had an aneurysm measuring 10 cm x 12 cm. Photo: PV

Very quickly, the surgical team removed all the blood damage, identified the upper and lower necks of the aneurysm and clamped it to prevent further blood loss. At the same time, the anesthesiologist performed hemodynamic enhancement with emergency blood and plasma transfusion. After that, the doctors treated the aneurysm by removing all the atherosclerotic plaque and blood clots in the lumen of the vessel; replacing the aneurysm and ruptured vessel with a new artificial vessel.

Master, Doctor Pham Van Chung - Deputy Head of the Department of Cardiovascular and Thoracic Surgery, Nghe An General Hospital said: During the surgery, the surgical team transfused 1.6 liters of blood to the patient. After the surgery, the patient was transferred to the Department of Intensive Care - Surgery. Here, through testing, the patient was still anemic, so an additional 0.5 liters of blood was transfused. The patient had common symptoms after emergency treatment for abdominal aortic aneurysm and rupture, such as low blood pressure, kidney failure, and blood clotting disorders. In addition, the patient had chronic lung disease due to long-term smoking, making the patient's recovery process even more difficult.

The ruptured aortic aneurysm was replaced with a new artificial artery. Photo: PV

After 5 days of intensive care, on June 10, the patient was transferred to the Cardiovascular Center, Nghe An General Hospital for continued treatment. Today, the patient's health has gradually stabilized. The patient can sit up, eat and take care of personal hygiene. Master, Doctor Pham Van Chung added: Saving the life of a patient with a ruptured abdominal aorta is one of the hospital's outstanding achievements. The mortality rate of patients with a ruptured abdominal aorta is very high, up to 60% - 80%. After emergency surgery, the patient may also suffer from many blood clotting disorders, liver failure, kidney failure, multiple organ failure leading to death.

It is known that the emergency surgery technique for a patient with abdominal aortic aneurysm and rupture was successfully performed for the first time at Nghe An General Hospital in 2015. Up to now, this technique has become routine. The hospital has successfully treated more than 40 patients with similar conditions.

Dr. Pham Hong Phuong - Director of the Cardiovascular Center, Deputy Director of Nghe An General Hospital shared: In fact, abdominal aortic aneurysm surgery and aortic replacement are difficult techniques; emergency surgery due to abdominal aortic aneurysm and rupture is even more difficult. The provincial General Hospital is one of the first hospitals to implement this technique.

After 6 days of intensive treatment, patient Nguyen Xuan Hai's health has gradually recovered. Photo: PV

Not satisfied with itself, in the coming time, the hospital will try to master the technique of thoracic aortic surgery (for a long time, patients with this condition often had to be transferred to a higher level). The technique of thoracic aortic surgery is more complicated, requiring careful preparation and smooth coordination. The hospital will send staff to study, invite leading experts in cardiac and vascular surgery from Bach Mai Hospital, Hanoi Heart Hospital and Viet Duc Hospital to coordinate training and transfer on-site.

Dr. Pham Hong Phuong recommends: To avoid aortic aneurysm and rupture, people with risk factors for cardiovascular disease, old age, smoking, diabetes, high blood pressure, peripheral vascular disease, etc. should go to hospitals with cardiovascular specialists for screening. The screening process is very simple, such as examining the peripheral vascular system, abdominal ultrasound, and vascular ultrasound to detect vascular lesions. Screening helps people detect and treat diseases early, avoiding emergency care, which is very dangerous.