Aneurism of the abdominal aorta arises from the same causes that give rise to aneurism of other parts. It occurs far less frequently than thoracic aneurism, however, and is found far more often in men than in women. It is usually saccular or fusiform, and located near the celiac axis.
Symptoms.—The most common as well as constant symptom, is pain, which may be sharp and lancinating in character, extending to the back and around the abdomen, or it may be of a dull, boring character, when there is erosion of the vertebra. There is. nearly always some gastric disturbance, attended by vomiting and pain, and jaundice is a common symptom. When the pressure is upon the liver, spleen, or kidneys, congestion of these organs follows, with the usual accompanying symptoms.
If there is erosion of the vertebra, paraplegia may follow. In rare cases the aneurism may perforate the diaphragm, and rupture into the pleura or lung. When it arises from the anterior wall, it may form a well-defined tumor. There is generally retardation of the femoral pulse.
Physical Signs.—Inspection may reveal pulsation in the epigastric region; and if the aneurism be on the anterior wall, a well-defined tumor is visible. The pulsation is heaving and expansile. and if near the diaphragm it is double; a diastolic shock from the heart may be recognized. A systolic thrill is sometimes noticeable.
Percussion reveals an abnormal area of dullness.
On auscultation, a soft bruit or murmur can usually be detected.
Diagnosis.—If we bear in mind that the pressure of a tumor that can be grasped in the hand, and which has a heaving, expansile pulsation, is the only positive diagnostic symptom, we will avoid many errors. The throbbing aorta occurs in neurasthenia and in anemia, and must not be mistaken for aneurism. It sometimes happens that a tumor of some of the abdominal viscera will be lifted with each abdominal pulsation, and may simulate aneurism.
If the patient be examined in the knee-chest position, however, the tumor will drop forward, when the pulsation ceases. It is also noticeable that the pulsation is not expansile.
Prognosis.—The prognosis is exceedingly grave, though very rarely, a case heals spontaneously. Sudden death may occur from rupture into the pleura, peritoneum, or intestines, or it may occur by obliterating the lumen by clots. Sometimes death is the result of paralysis induced by erosion of the vertebra.
Treatment.—The treatment of abdominal aneurism will be on the same principle adopted for thoracic aneurism. Firm pressure for hours, the patient being anesthetized, has been practiced with some degree of success, though there is always danger of rupturing the aneurism by this means.
The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.