J.Jpn. Surg. Soc.. 87(7): 803-807, 1986
Original article
SURGICAL APPROACH TO THE ABDOMINAL AORTIC ANEURYSM WITH ALIMENTARY TRACT MALIGNANT TUMOR : REPORT OF THREE CASES
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First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan Hidemaro Nakano, Kensuke Esato, Masaki Ohara, Hitoshi Mohri |
A 70-year-old man with cancer of the coecum and an infra-renal abdominal aneurysm, was diagnosed preoperatively, and a simultaneous right hemicolectomy and aneurysmectomy were carried out. In the other patient, a 77-year-old man, presence of the gastric cancer was incidentally found at laparotomy and a 75 percent gastrectomy and an aneurysmectomy were carried out. In the third patient, both gastric cancer and an abdominal aneurysm were detected preoperatively. Distal partial gastrectomy was performed first because of severe epigastralgia and an asymptomatic aneurysm. The abdominal aneurysmectomy was carried out six months Iater.
All patients were treated by daily administration of Cefazolin sodium or Cefalotin sodium (4－10g) and Dibekacin sulfate (200mg) for seven to ten days postoperatively. In the case of second look operation, however, Fosfomycin 2－4g/day was added to the above mentioned drug following the aneurysmectomy.
All tolerated surgery well without any signs of infections. The first patient died on the 57th postoperative day from panperitonitis carcinomatosa following an episode of intestinal obstruction.
Selection of the operative approaches for patients having both an alimentary tract malignant tumor and an abdominal aortic aneurysm was difficult, although the initial surgical intervention for the more life threatening lesion would be better justified. Some surgeons object a simultaneous resection due to fear of the graft infection. The present experience, however, warrants the application of simultaneous resection of an aneurysm and an alimentary tract malignant lesion.
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