A fissured aortic aneurysm accidentally detected thanks to a symptomatic retroperitoneal leiomyosarcoma: Case report

We present the case of a concomitant retroperitoneal leiomyosarcoma and a fissured abdominal aortic aneurysm. Coexistence of these two pathologies is itself rare, but in our case we observed a singular presentation, that avoided the surgical emergence which represents the inspected rupture of an aortic aneurysm for an unaware patient. In fact, our subject presented to emergency with a symptomatology related to a complication of the neoplasm, but imaging exams let us discover an unknown fissured aortic aneurysm in a pre-rupture phase. The abdominal pain to the left flank referred by our patient was due, in fact, to an intraparenchimal hemmorage. The CT scan demonstrated an aortic aneurysmatic dilation with signs of recent bleeding, compatible with a tamponed fissured aneurysm. In these cases, the treatment strategy must consider if a combined surgery can be performed, or if the most urgent pathology must be addressed first. In our case, the patient was submitted to a combined operation of abdominal and vascular surgery few days after the accidental diagnosis of his life-Threatening condition, with macroscopical complete excision of the neoplasm and aneurysm repair with aorto-Aortic graft. No short or middle-Time complications occurred, but six-months follow-up revealed a neoplasm relapse, confirming the local aggressiveness of leiomyosarcomas.