Massive Infra-renal Abdominal Aortic Aneurysm: Case Report and Literature Review

An aneurysm is a localized dilatation in a blood vessel wall, typically in an artery, resulting from a defect, illness, or injury. It can be life-threatening, especially when it involves the abdominal aorta. Risk factors include atherosclerosis, smoking, hypertension, advanced age, family history, and male gender. Its prevalence ranges from 12.5% in males to 5.2% in females. A 65-year-old male with no known risk factor for cardiovascular disease presented with lower back pain for five years and erectile dysfunction for more than 20 years. On examination, a pulsating epigastric mass was found. A regular abdominal ultrasound examination revealed an epigastric mass. Routine investigations and echocardiography were unremarkable. Computed Tomography abdominal angiography revealed a large infra-renal abdominal aortic aneurysm (AAA), patent centrally with a peripheral mural thrombus opposite the second, third, and fourth lumbar vertebrae. There were no features indicating a rupture. An elective AAA repair was performed through a standard midline trans-peritoneal approach. A Dacron graft measuring 18 mm was applied for the repair. Both the surgery and the post-operative recovery were uneventful. At the time of the report, the patient has been alive and well been periodically followed up for over 18 months since the operation. Conclusion: Early diagnosis of infrarenal AAAs is critical due to the significant death rate associated with rupture. A high level of suspicion is required for diagnosis of cases with unusual presentations such as vague abdominal and back pain and early erectile dysfunction.