Abdominal aortic aneurysm: Perianeurysmal fibrosis and ureteric obstruction and deviation

Abstract

Seven cases of ureteric obstruction and one case with bilateral medial ureteric deviation complicating inflammatory aneurysm of the aorta are reported. The value of routine preoperative pyelography in all patients with abdominal aortic aneurysm is emphasized. Diagnostic difficulties that may arise when these conditions coexist are discussed. Our experience suggests that these patients are best treated by both aneurysmectomy and ureterolysis and that long-term follow-up is advisable.

Diagnosis of Aortic Aneurysm

“…Interestingly the majority (85%) of these aneurysms are palpable at the time of diagnosis while one fourth are tender and have a bruit. There are several reports of these patients having a moderate rise in the erythrocyte sedimentation rate (Bainbridge and Woodward 1982;Darke, Glass et al 1977;Pennell, Hollier et al 1985) and this would further strengthen the accuracy of diagnosis of inflammatory aneurysms in symptomatic patients. Nevertheless the classic triad of chronic abdominal or back pain, elevated ESR, and weight loss is rare, implying a low diagnostic sensitivity but has high specificity for inflammatory aneurysms.…”

Abdominal aortic aneurysm with retroperitoneal fibrosis and ureteric entrapment

“…However, in B. Sethia and S. G. Darke the presence of hydronephrosis, ureterolysis is indicated. Failure to do this has been reported as leading to persistent obstruction (1).…”

“…Otherwise unremarkable abdominal aortic aneurysms may, o n occasion, be associated with a periaortic inflammatory process which is macroscopically indistinguishable from idiopathic retroperitoneal fibrosis, and ureteric entrapment and renal impairment may occur (1,2). When these conditions coexist, they present special problems in terms of diagnosis and management.…”

Idiopathic Retroperitoneal Fibrosis – An Update

“…In most aneurysms of the aorta, however large they may be, the ureter is not involved. Darke et al [8], in a retrospective review of 117 patients whose abdominal aneurysms had been treated surgically, found 7 with ureteric obstruction and periaortic fibrosis. The histological changes in the fibrous tissue around an aneurysm were similar to those found in RPF.…”

“…84], In most of these cases the aneurysm is 'small and in other respects unremarkable' [85]. However, a warning is given [8] that this type of aneurysm is not exempt from the serious complication of rupture so that surgical treatment is indi cated ab initio if that risk is thought to be present.…”