Antenatally Diagnosed Abdominal Aortic Aneurysm in a New Born: A Case Report and Review.

Sir,

We report a full term newborn who was asymptomatic[1] with infrarenal abdominal aortic aneurysm diagnosed during the antenatal period [Figure 1]. Surgery was electively done on day 8 of life by the gastrosurgery department. A 6-mm polytetrafluoroethylene (PTFE) graft was used for aortic reconstruction with proximal anastomosis to the aorta, distally to the right external iliac artery, and the origin of the left external iliac artery was reimplanted on to the graft. Postoperatively, bilateral femoral arterial pulsations were documented by Doppler, and urine output was adequate.

Figure 1

Fusiform aneurysm of infrarenal abdominal aorta measuring 6.4 cm × 3.2 cm, with bilateral iliac arising from it. The aorta above measured 5 mm in diameter

At 5 months of life, a computed tomographic aortogram done showed the right external iliac artery occluded with distal reformation of the right common femoral artery with collaterals. Left external iliac artery near the aorta was occluded with retrograde filling with collaterals. Left common femoral artery appeared normal [Figure 2]. It also showed right-sided moderate hydroureteronephrosis with dilatation of the right ureter up to surgical site. The baby was admitted at the 7th month of life with Klebsiella pneumonia urinary tract infection. An micturating cystourethrogram done after recovery showed no evidence of vesicoureteric reflux.

Figure 2

Occlusion of right common iliac artery, right external iliac artery, and left external iliac artery with distal filling

A DTPA scan performed at 8 months showed a hydroureteronephrotic right kidney with a relative function of 39% and normal left kidney. At 9 months of life, a right ureteroureterostomy was performed. Intraoperatively, the right ureter was seen crossing the vascular graft posteriorly with dense adhesions around causing obstruction with proximal gross ureteric dilatation.

In cases like these, following surgery ureteral stenosis can occur, if there is any devascularization or inflammation. The symptoms may be delayed by months and occur in about 1%–2% of patients.[2] The pressure on ureter coursing posterior to the graft could have been avoided to a significant extent here by placing the graft posterior to the ureter. Further, a careful dissection of ureter taking care not to disrupt the blood supply would help to reduce the fibrosis around it. In conclusion, during follow-up, appropriate imaging is required to ascertain that the kidneys and ureters are normal with no evidence of obstruction and subsequent sequelae.

Financial support and sponsorship

I (Rahul Baby) would like to thank my consultants Dr. Sasidharan and Dr. Naveen for guiding me in this report.

Conflicts of interest

There are no conflicts of interest.