Surgical Correction of Tuberculous Pseudoaneurysm of Upper Abdominal Aorta

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Abstract
Aneurysm of the aorta secondary to tuberculosis is a rare condition. The diagnosis should be considered when there is a pulsatile abdominal mass lacking calcification on X-ray, associated with a low grade fever. If the patient has known pulmonary tuberculosis or tuberculous spondylitis, the diagnosis is even more likely. Difficulties involved in surgical management include early diagnosis, aortoduodenal fistula and graft rejection due to infection. A case is presented of a large pseudoaneurysm of the epigastric aorta secondary to tuberculosis spondylitis. Recommended treatment is Dacron bypass graft replacement from the lower thoracic aorta to the infrarenal aorta. The aorta is then ligated above and below the aneurysm, thus removing its pulsatile flow. Perfusion of the abdominal viscera is via the superior mesenteric artery in a retrograde fashion. Three points are stressed. The graft will not be rejected because of tuberculous contamination if it is placed away from the area of infection. Adequate visceral blood flow is maintained if the superior mesenteric artery is patent and the celiac artery is ligated no further distally than its trifurcation. The aneurysm itself need not be resected.