Discussion
In the Democratic Republic of the Congo, data on AAA are not available,
so the report of this case contributes to the improvement of the
management of AAA in its Eastern part particularly in a limited
resources context.
Several risk factors have been previously described to be associated
with AAA. Among them, age superior to 65 male gender family history of
AAA smoking habits and cardiovascular comorbidities like obesity
hypercholesterolemia except diabetes are known 8–10.
As far as our patient are concerned, cardiovascular comorbidities were
the one found; arterial hypertension and obesity. Contrarily to what has
been described in the literature about male gender association with AAA
our patient was female and as said before at the same advanced age,
women are more exposed to the risk of ruptured of AAA.
AAA are most of times asymptomatic and when symptomatic, sensation of a
pulsatile mass reveals it. Furthermore some AAA become symptomatic at
the catastrophic stage of rupture. Abdominal pain palpitations loos of
consciousness and sensation of a pulsatile mass in the left flank were
the majors symptoms that motivated our patient to consult in a referral
hospital and the only particularity found on his physical examination
was a pulsatile abdominal mass that was also the major clinical sign
found in our patient as it remains the main founding in approximately
30% of AAAs clinically11.
Imaging reveal that our AAA was located in the sub renal area and it has
an AP diameter of 69 mm within it posterior wall a thrombus of 34 X 20
mm X 51 mm (LL X AP X CC). These finding corroborated what is described
in the literature. In fact it has been described that more AAA was
located in the sub renal area, and the AP diameter superior to 65mm is
the risk factor of rupture of AAA according to the joint Council of the
Society for Vascular Surgery Practice 12.
Preventive treatment consist on prevention of cardiovascular
comorbidities and more frequented checkup when there is a family history
of AAA or at a certain advanced age13. Currently, it
has been described that endoscopic treatment is the gold standard in AAA
repairs by endoprothesis. Open surgery did not lose it place especially
then the AAA is already ruptured and the one who is practiced in some
remote areas like ours11. Although it has been so many
postoperative complications of which vascular (thromboembolic,
hemorrhagic), cardiac (a cardiac insufficiency or disorder of the
rhythm, a myocardial suffering), pulmonary (the basic pneumopathies),
renal (tubulopathies), septic are expected our patient did not developed
no one of them from the surgery to discharge9,10,13.
There were not any immediate or delayed pot operative noticed at
discharge and 3 months’ check even at 6 months’ check,