Case of the Month: Rare cause of Abdominal Pain

Operative photo and schematic of the aortic reconstruction 

Abdominal Pain ?

Elderly woman with high blood pressure, history of smoking who was complaining of abdominal pain for 6 months.  She underwent a CT scan of the abdomen.  The CT scan showed a 12-centimeter thoracoabdominal aortic aneurysm.  The aneurysm was classified as a type V Crawford thoracoabdominal aortic aneurysm.  She was admitted to the hospital for complete cardiac work-up.  After her work-up was completed she underwent a thoracoabdominal aortic aneurysm repair from the lower thoracic aorta to the just above the aortic bifurcation (see figure).  The blood supply to the abdominal organs was reconstructed with individual grafts. The spinal cord was protected with the use of lumbar CSF drainage, intra-operative neuromonitoring, and liberal use of hypothermia. The patient did well after surgery.