Recovery aspects in a case of incomplet paraplegia with a T11 neurological level, acute postischemia due to a hemorrhageic shock through an aorto-sigmoid fistula and communicative anastomotic pseudoaneurysm – Case report

Abstract

Introduction:The pseudo aneurysm is an accumulation of blood between the muscle and the adventitia of an artery, while a genuine aneurysm is "a permanent and localized dilation which determines an increase of more than 50% in the normal diameter of the respective vessel" [1], [2]. Aneurysms are more common in the aorta and most frequently occur in male patients aged between 65-85 years, representing 1-3% of the total death causes in this group of age. [3], [4]. Material and methods:The paper presents the case of a 53-year old patient with incomplete paraplegia, AIS/Frankel D with a T11 neurologic level, acute post-ischemia due to a hemorrhagic shock. The patient was diagnosed in 2017 with ruptured right iliac aneurysm which required surgery. A right iliac exograft was inserted, which later became infected, thus requiring multiple surgical interventions, the patient remaining a chronic carrier of Enterococus Faecium. Subsequently, multiple pseudo aneurysms begin appear in the right and left iliac artery and aortic bifurcation. Multiple surgical inetervention ware performed. In January 2018, the patient presented himself with an emergency to the hospital, with a hemorrhagic shock. He was diagnosed with anastomotic pseudo aneurysm which communicated through a very long path with a fistula at the level of the sigma, showing small amounts of a periprosthetic collection with purulent aspect. Surgery is reinitiated by insertion of an axillo-bifemoral bypass and Hartman resection with colostomy. Another important element in the pathological history of the patient is operated pulmonary neoplasm with hepatic and bone metastases. The patient was clinically and functionally evaluated, according the standardized protocols implemented in our clinic, through the assessment scales (AIS, FIM, QoL-Quality of Life, Asworth, Penn, FAC, WISCI II) and also paraclinically, in order to evaluate his biological reserve and his bearing availability of the recovery program. Results: The patient presented a slowly favorable evolution (slowed down by his multiple above mentioned comorbidities) from an algo-dysfunctional point of view, with the improvement of the walking program and the increase of muscle force and individual autonomy. Conclusion: Although aortic aneurysms are common between 65-85 years of age, they can also appear at younger ages. The aortoenteric fistula is a rare cause of massive gastrointestinal bleeding, many of them leading to the death of the patient before presentation to the doctor. Although medullary ischemia can lead to neurologic deficit of the paraplegic type, it can be corrected through a complex recovery program.