Abdominal aortic aneurysm mimicking the cause of gastric obstruction.

A case of abdominal aortic aneurysm appeared to be compression of the antrum of the stomach and was suspected of causing a gastric obstruction. However, an upper gastrointestinal endoscopy to rule out an obstruction by a tumor revealed a gastric tumor, thus avoiding unnecessary intervention, such as open surgery.

An 83‐year‐old man presented with nausea and severe vomiting. Computed tomography showed a remarkable gastric dilation (Figure 1A) and a 63 mm infrarenal abdominal aortic aneurysm (AAA) (Figure 1B). The AAA appeared to be compression of the antrum of the stomach, demonstrating a caliber change (Figure 2), and was suspected of causing a gastric obstruction. He was referred for aneurysm resection to release the compression. Upper gastrointestinal endoscopy to plan the surgical strategy revealed entire circular stenosis, rather than compression from one direction (Figure 3). Therefore, we judged that the obstruction was caused by gastric organic lesions, such as tumors, and that the AAA was unrelated. We performed endovascular aortic repair (EVAR), not open surgery, considering the possibility of subsequent surgical treatment for the gastric tumor. The postoperative course was uneventful. Pathological examination during endoscopy revealed adenocarcinoma, and gastrectomy was performed later.

FIGURE 1

(A) Computed tomography showed a remarkable gastric dilation (red asterisk). (B) Computed tomography showed a 63 mm infrarenal abdominal aortic aneurysm (yellow arrow)

FIGURE 2

Abdominal aortic aneurysm looked like compression of the antrum of the stomach, demonstrating a caliber change (red arrow)

FIGURE 3

Upper gastrointestinal endoscopy showed entire circular stenosis of the antrum of the stomach rather than compression from one direction

Gastrointestinal obstruction by an AAA occurs rarely and usually affects the duodenum, but the stomach is not a retroperitoneal organ. Therefore, we considered that the AAA was unlikely to cause a gastric obstruction. Clinicians should consider obstruction by a tumor as a possibility in patients with gastrointestinal obstruction, even if the obstruction appears to be caused by compression by an AAA.

CONFLICTS OF INTERESTS

The authors declare that there are no conflicts of interest.

AUTHOR CONTRIBUTION

SI wrote the draft of the manuscript and prepared the figures. SI and TI involved in writing, and revised and approved the final manuscript.

ETHICAL APPROVAL

Institutional review board approval was exempted at our institution for this retrospectively designed report, and informed consent was obtained from the patient to publish this report.

CONSENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.