The response of peri-aneurysmal fibrosis--the "inflammatory" aneurysm--to surgery and steroid therapy.

It is generally thought that the fibrotic process associated with an "inflammatory" aneurysm abates with operative repair. This paper reports a patient in whom the inflammatory process was accelerated after surgery leading to the development of subacute small bowel obstruction and worsening urinary tract obstruction in the postoperative period. Graft sepsis was suspected but all cultures were negative and his condition deteriorated on broad-spectrum antibiotics. Steroid therapy, however, resulted in a prompt reversal of symptoms, signs and objective evidence of obstruction. The problems of investigation of peri-aneurysmal fibrosis and graft sepsis are discussed. Possible aetiological factors and the relationship between the "inflammatory" aneurysm and idiopathic retroperitoneal fibrosis are considered.