Huge infra renal abdominal aortic aneurysm presented with concomitant divirticular abscess: A case report

A systematic review and case presentation: Giant abdominal aortic aneurysm

OBJECTIVE

An abdominal aortic aneurysm is considered giant when its transverse diameter is greater than 10-13 cm in diameter. A giant abdominal aortic aneurysm is rare but with a significant risk of rupture if it is not diagnosed or left untreated.

METHOD

The authors have performed a systematic review of the evidence that has looked into the clinical presentations, and management methods employed and have presented a 14 cm giant abdominal aortic aneurysm patient.

RESULTS

The systematic review has been based on level-IV evidence due to the rarity of the condition. The final analysis included 61 relevant reported cases. The mean age was 72.4 years, the male to female ratio was 52: 8, and the average size of a giant abdominal aortic aneurysm was 14.7 cm. These were mostly infra renal (72.58%). Rupture of these aneurysms was found in 23 (37.1%) patients, and was treated by laparotomy in 51 (82.25%) cases. There were 11 (17.74%) mortalities.

CONCLUSION

The size of an abdominal aortic aneurysm is known to be the biggest factor in the rupture of an aneurysm. The reason abdominal aortic aneurysms can reach such size without rupturing is unclear but needs further exploring. Early diagnosis with effective screening programmes is essential to diagnose in a timely manner to avoid life-threatening consequences.

Abdominal aortic aneurysm and acute appendicitis: a case report and review of the literature

Background

Abdominal aortic aneurysm and acute appendicitis occur relatively frequently in elderly patients. However, the co-occurrence of the two pathologies is very rare and serious.

Case presentation

We present the case of an elderly Caucasian patient who was aware of having an abdominal aortic aneurysm but refused treatment and was subsequently admitted to the hospital’s emergency department with acute abdominal symptoms. A computed tomography scan raised the possibility of complication due to the characteristics of the aneurysm. The patient then agreed to emergency surgery. Laparotomy revealed the existence of an acute perforated appendicitis with a significant abscess in the right iliac fossa and an uncomplicated aneurysm. Appendectomy was performed and the abscess drained. The postoperative period passed without complications, and the patient again refused surgery for the aneurysm, which due to its anatomical characteristics was not a candidate for standard endovascular treatment.

Conclusions

In light of this experience, we review the literature about the relationship between abdominal aortic aneurysm and acute appendicitis.

A mixed method study to validate a two-way feedback between student and faculty to improve learning of anatomy

Although the students are subjected to some formative exams throughout the problem based learning units, feedback is not given appropriately and timely. Students want to know and use the reasoning behind judgments and always complain that assessment criteria need to be explained. The aim of this project is to implement a two-way feedback delivery (TWFD), in which both faculty and students have an opportunity to discuss their reflections on learning and examination processes. An Anatomy formative assessment is introduced to 100 students followed by implementation of TWFD. Faculty members provided the students with a structured and timely feedback on their performance. Also, the students reflected on the whole learning process, including real examination experience. The reaction was measured using quantitative and qualitative instruments through a questionnaire, focus group discussion, and semi-structured interviews. Ninety students (90%) participated in the questionnaire with high satisfaction toward implementation of TWFD. Ninety-four percent (n=85) admitted that the time of the session was appropriate. Ninety percent (n=81) of the students demonstrated that the TWFD helped them to identify their strengths and weaknesses. Eighty-five percent (n=77) of the students admitted that TWFD promotes active reflection on the effectiveness of teaching. Most of the students and teachers' comments in the focus group discussions and the interviews supported these results. TWFD seems to be a good approach to implement an effective and timely feedback process between the faculty and the students. Students and the faculty recommended the implementation of this session in different courses and units.