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Abstract: The patient in this case reported vague abdominal pain for more than one month without acid reflux and belching, black stool or bloody stool, and did not pay much attention to it until two days ago, when the abdominal pain worsened and continued to be painful, so she came to the hospital. The diagnosis of abdominal aortic coarctation was confirmed by physical examination and enhanced CT examination, and he was admitted to the hospital for treatment. After admission, aortic stenting was performed and anti-infection treatment was given. After 3 days of continued monitoring, the patient was discharged with significant relief of abdominal pain and no other discomfort.
Basic information】Male, 56 years old
Disease Type】Abdominal aortic coarctation
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】January 2022
Treatment plan】Surgical treatment (aortic stenting) + anti-infection treatment (penicillin sodium for injection)
Treatment period】9 days of hospitalization and 1 month of outpatient follow-up
Treatment effect] The patient’s abdominal pain was significantly relieved, the condition was controlled, and all indicators were improving.
I. Initial consultation
The patient was a 56-year-old male who came to the hospital for abdominal pain. During the consultation, it was observed that the patient was mentally unwell, with a fair complexion, and his left hand kept pressing the abdomen. On initial examination, the patient had a temperature of 36.5°C, blood pressure of 118/75 mmHg, heart rate of 73 beats/min, and respiratory rate of 18 breaths/min. On examination: bilateral pupils were equal in size and round, sensitive to light; no cyanosis in the mouth, no enlargement of tonsils, no resistance in the neck, negative hepatocervical reflux sign, no enlargement of thyroid gland; trachea in the center, clear respiratory sounds in both lungs, no rales heard; no elevation in the precordial area, rhythm is uniform, no murmur heard in each valve area; abdomen is flat and soft, no mass is palpated, liver and spleen are not found under the ribs; no percussion pain in the liver area, negative mobile turbid sounds, normal intestinal sounds. To further confirm the diagnosis, an enhanced CT examination was prescribed, which showed thickening of the abdominal aorta, true and false lumen formation and endothelial lamina, ranging from the aortic arch to the common iliac artery on one side (see figure below). Preliminary diagnosis: abdominal aortic coarctation, and was admitted to the hospital. The patient had no previous abnormalities, no history of drug allergies, and a history of smoking for more than 30 years, 15-20 cigarettes per day.
(CTA showed thickening of the abdominal aorta with true and false lumen formation and intimal lamellae, ranging from the aortic arch to one side of the common iliac artery)
II. Treatment history
After admission, the patient continued to improve liver and kidney function, coagulation, cardiac enzymes and other related tests, and the results showed: elevated white blood cell count and different classifications, elevated C-reactive protein, but no other significant abnormalities; electrocardiogram showed sinus rhythm; physical examination showed no significant abnormalities; CTA showed thickening of the abdominal aorta, true and false lumen formation and intimal lamina, ranging from the aortic arch to one side of the common iliac artery; therefore, the diagnosis of abdominal aorta was further confirmed After communication with the patient’s family, the patient was treated surgically, and preoperative water fasting was performed. The patient was transferred to the ward and given anti-infection treatment with intravenous penicillin sodium for injection.
III. Treatment effect
The patient continued to be monitored postoperatively, and blood pressure, heart rate, temperature, respiration, and oxygen saturation were all normal. The patient complained of no discomfort, abdominal pain was relieved, and his physical examination was normal. The patient was continuously monitored, and the three major routine, liver and kidney functions, coagulation, cardiac enzymes, CTA and other related tests were reviewed, and the results showed that the patient’s indicators were improving, and the aorta had good morphology and no endoleaks after surgery. After 9 days of hospitalization, the patient’s condition was basically controlled, and he was discharged after communication with the patient and his family and comprehensive evaluation. After discharge, the patient followed the doctor’s orders, took medication on time, and actively did postoperative rehabilitation care at home. At the outpatient review one month later, the patient was observed to have a rosy complexion, good mental status, clear speech, good postoperative recovery, good postoperative aortic morphology, no endoleaks, and no abdominal pain and other symptoms, so the patient was judged to be basically cured.
IV. Notes
We are glad that the patient has basically recovered, but we still need to advise the patient that the prognosis is very uncertain, and we need to pay attention to discharge care, so the patient needs to strictly comply with the medical advice, for activity and diet, we should follow the transition from less to more exercise, from light to heavy; for diet, gradually transition from a small amount of liquid diet to normal diet, do not rush to return to normal, which will cause the disease to recur. Avoid alcohol abuse, overeating, high-fat diet, etc. Pay more attention to rest, relax, eat reasonably, take medication on time, and review on time. Advise family members to pay attention to the patient’s diet, urine and stool, body temperature and other conditions on a daily basis. Once abnormal changes occur, such as fever, loss of appetite, diarrhea, constipation, frequent urination, urinary urgency and reduced urine volume, etc., it indicates the progress of the disease and the need for timely medical consultation.
V. Personal insight
Acute abdomen is a category of acute diseases with abdominal pain as the main clinical manifestation, acute abdominal pain caused by infection, rupture and perforation of various organs. In this paper, the patient is abdominal aortic entrapment, which is a kind of acute abdominal disease. Aortic entrapment means that the blood in the aortic lumen enters the aortic mesentery from the aortic endothelial tear, so that the mesentery separates and expands in the direction of the long axis of the aorta to form a state of separation between the true and false lumens of the aortic wall. For acute abdominal disease, its treatment consists of a comprehensive treatment plan including general treatment such as water fasting and gastrointestinal decompression, drugs, and surgery. Unhealthy eating habits and strenuous exercise are often used as triggers of acute abdominal disease. So on a daily basis, how should we prevent it?
1, there is no specific preventive measures for this kind of disease, but daily we pay attention to the lifestyle will still effectively delay the occurrence of the disease. First of all, the need to correctly understand the disease, especially for some small pain, can not be ignored, many times, some major diseases are due to bad habits, resulting in disease in a part of the body, and these diseases are not specific, but also often ignored by everyone, and finally, dragged into a major disease, so, should be regular medical checkups, early detection and early treatment.
2, to develop good habits and eating habits, now the majority, especially young people are “fast food culture”, do not pay attention to diet, overeating, high sugar and high fat, etc., should avoid this kind of diet, usually more light, high dietary nutrition, more vegetables and fruits, avoid spicy stimulating things, less carbonated drinks, coffee, strong tea, alcohol, etc. Avoid drinking carbonated beverages, coffee, strong tea, alcohol, etc., quit smoking and alcohol, and eat reasonably; keep good sleep, do not stay up late, go to bed early and wake up early; do more exercise to enhance immunity and resistance.
3, maintain a happy mood, family members should create a comfortable and relaxed family environment, pay attention to the patient’s mental state, avoid aggravating the patient’s psychological burden, and give the patient full psychological comfort. Patients themselves should also maintain a positive attitude, face the disease squarely and cooperate with doctors.