Patient N.T. N. (67 years old, Xom Chieu ward, Ho Chi Minh City) was admitted to the hospital in a state of severe abdominal pain around the navel. Previously, Mr. N. had symptoms of dull abdominal pain, bloating and thought that this might just be a common digestive problem.
At the Emergency Department, Gia Dinh People's Hospital, the main facility, after initial examination, doctors determined that the patient's abdominal pain symptoms showed signs suggesting dangerous vascular damage. The consultation procedure was immediately activated. The patient underwent necessary blood tests and was prescribed a multi-slice CT scan with a contrast scan to survey the blood vessel system.
The results of a blood vessel CT scan showed that Mr. N. had a large abdominal aortic aneurysm in the lower segment of the kidney, and the blood vessel wall appeared in many thin positions, showing signs of threatening rupture. In addition, the related blood vessel system was severely calcified, making the pathological condition more complicated.
However, the biggest challenge of the case is not only stopping at the about-to-break aneurysm, but lies in the overall extremely serious underlying pathology of the patient. Mr. N. also has co-infections including: bilateral carotid artery stenosis over 50% (very high risk of stroke when blood pressure fluctuates), chronic obstructive pulmonary disease (COPD) causing respiratory impairment and especially stage 4 chronic kidney failure - the imminent boundary of periodic dialysis and very sensitive to contrast agents as well as anemia during surgery.
Faced with this difficult situation, a consultation between specialists decided to choose the classic open surgery method: removing the subrenal abdominal aortic aneurysm and replacing it with an artificial graft.
Assoc. Prof. Dr. Tran Minh Bao Luan, Deputy Head of Thoracic Surgery - Vascular Surgery Department, Gia Dinh People's Hospital, said: "The difficulty of this major surgery is the control and stitching of blood vessels in the position below the kidney. The patient's vascular wall has become atherosclerosis, damaged in many places, so it is very fragile, the placement of each stitch must be done extremely accurately to avoid further tearing the already damaged vascular wall. Just a small mistake in controlling flow pressure or stitching incompletely, bleeding can occur seriously and is very difficult to control.
After nearly 4 hours of high concentration, the surgery was successfully completed.
MSc. Dr. Nguyen Hung Truong, Department of Thoracic Surgery - Vascular Surgery, said that this disease is likened to a "delayed bomb" because it progresses silently, with almost no obvious symptoms in the early stages. However, when the bulge ruptures, patients may experience massive blood loss, leading to rapid death. If the bulge ruptures into the peritoneum, the actual mortality rate can be up to more than 80%, many cases do not have time to reach the operating table," MSc. Dr. Nguyen Hung Truong warned.
