Doctors at Manipal Hospital, Gurugram successfully treat 70-year-old male suffering from fatal abdominal aortic aneurysm

Gurugram : Recently, a 70-year-old man with a ruptured abdominal aortic aneurysm was successfully treated at Manipal Hospital, Gurugram. The patient presented to the hospital with complaint of persistent back pain, fever, severe hypotension, and cold sweats. He had a history of fever for past 1 month which was managed with antibiotics. Upon investigation, the CT scan revealed that the patient had a hole in the back wall of his aorta causing blood leakage in the abdomen. Looking at his condition, Dr. Manmohan Singh Chauhan, Head of CTVS (Cardiothoracic & Vascular Surgery), and his team comprising of Sr. Cardiac Anesthesiologist Dr. Jitumoni Baishya, immediately counselled the patient’s family and performed an emergency surgery where the infected aorta was removed along with the blood clots and were replaced with a prosthetic graft.

Mycotic (infected) aneurysms are very rare accounting for just 0.7-3% of aortic aneurysms. Bacterial seeding results in infection of the arterial wall which ultimately leads to focal breakdown of the vessel wall. A multidisciplinary approach was used in the post-operative period because of multiple co-morbidities like advanced age, hypertension, diabetes, chronic liver disease, chronic kidney disease, hypoproteinemia, and severe anemia. The surgical procedure was challenging as the aorta was covered by a thick layer of reactive tissue consistent with chronic infection of the arterial wall making it even more difficult, especially in an emergency setting with massive blood loss and low blood pressure. It is a catastrophic emergency that if not recognized and appropriately treated, leads to death in 99.9% of patients.

Commenting on the challenges of this case, Dr. Manmohan Singh Chauhan, Consultant and Head – CTVS, Manipal Hospital, Gurugram, said, “Sudden rupture of the infected major blood vessel like the Aorta is a life-threatening emergency as most of the patients don’t even reach the hospital on time and succumb to death due to internal bleeding. Surgery itself carries a very high risk requiring safe anesthesia technique for smooth induction specially in patients with active bleeding. The chances of survival in an elderly patient with multi-organ issues are limited. During the surgery, the infected segment of the blood vessel is identified and removed to be replaced by a graft. These patients require multiple blood transfusions, and the chances of post-operative multi-organ failure are very high. Swift and well-planned surgical approach with safe anesthesia technique and a well co-ordinated post-operative multi-disciplinary strategy at Manipal Hospital Gurugram led to a positive outcome in this patient.”