Abdominal Aorta.
Symptoms.—Aneurism of the abdom inal aorta is uncommon, as compared to that of the thoracic aorta. It usually occurs near the coeliac axis, where it may form a fusiform, sacculated, or multiple tumor; this may project back ward, and either erode the vertebra?, causing subsequent numbness and tin gling in the legs, which may be followed by paraplegia, or it may burst into the pleura.
This form of aneurism, however, usu ally projects forward either in the middle line of the abdomen or somewhat to the left. If it is located high up, and under the pillar of the diaphragm, it may be beyond the reach of the hand in palpa tion.
There usually are disorders of diges tion, especially vomiting and pain, the latter frequently simulating cardialgia. It may be located either in the back or resemble girdle pains, passing around the sides to the back.
Case of aneurism of the abdominal aorta, with symptoms of renal colic. Cheadle (Lancet, Nov. 20, '97).
A distinct tumor is generally visible in the epigastric region. Locally, pulsa tion may be detected, while a thrill may frequently be observed when the hand is applied over it.
Palpation usually reveals the presence of a definite tumor, showing a strong expansile effort; the pulsations may be double in character when the aneurism is large and brought in contact with the pericardium.
Percussion may elicit a certain amount of dullness, usually intermingling with the dullness of the left lobe of the liver.
Auscultation will usually reveal a sys tolic murmur, and at times a very soft diastolic murmur. The former is fre quently best heard by auscultating be hind, near the spinal column.
Differential Diagnosis.—A throbbing aorta is frequently mistaken for an an eurism. An abdominal aneurism should not be declared piesent unless a definite expansile, pulsatile, and graspable tumor can be felt, notwithstanding the presence of a forcible pulsation, a thrill, or a sys tolic murmur.
Tumors of the left lobe of the liver, of the pancreas, and of the pylorus may all be influenced by the movement of the aorta and suggest aneurism, but there is no expansile action in tumors, and, if the patient be placed in the knee-elbow posi tion, the pulsation will usually not be felt, owing to the tumor falling forward by its weight and thus being no longer in contact with the aorta.
Prognosis.—The prognosis is unfavor able, although a few cases of spontaneous recovery have been observed.
Death may be due to compression of the spinal cord; paraplegia and its re sults; to embolism of the superior mes enteric artery followed by infarction of the bowels; to the aneurism bursting into the retroperitoneal tissues, the peri toneum, or the intestine, usually the duodenum, or into the pleura; or finally to the abdominal aorta becoming oblit erated by clots. (Osler.) Treatment. — The treatment of ab dominal aneurism is the same as that of aneurism of the thoracic aorta.
Pressure of the aorta above the sac has been successfully tried in a case where the aneurism was localized low down; but it should be remembered that trau matism of the sac has caused death in similar cases. Should this treatment be selected the pressure should be continued for many hours, under chloroform.
Case of aneurism of the abdominal aorta causing death by rupture into the stomach. Great danger of the adminis tration of ergot in aneurisms. greatest in cases where the walls of the sac were more than ordinarily attenuated, or where the tendency to atheroma was marked. Ridley-Bailey (Brit. Med. Jour., July 11, '91).
The introduction of gold or silver wire, with or without the assistance of electric ity, have been used with success.
Case in which aneurism of abdominal aorta was exposed by a free abdominal incision, and a hollow, gold-tipped needle inserted into the sac. Through this was passed eight and one-half feet of No. 30 gold wire, which was connected with the positive pole of the battery; a clay plate placed under the buttocks was connected with the negative pole. The current was gradually increased to 70 milliamperes during half an hour. The pulsation in the tumor lessened, but the patient be came collapsed and cyanosed, reviving, however, later under stimulant treat ment. The wire was left in the sac, and the wound closed. Patient died six months later from some other affection, but there was no recurrence of the aneu rism. Of 11 other cases treated in this way by other surgeons, 4 resulted in ap parent cure and 6 improved. W. H. Noble (Phila. Med. Jour., June 25, '98).