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,