Spontaneous Perforation of a Non-Aneurysmal Visceral Aorta

A 77 year-old woman with mild osteoarthritis and Sjögren's Syndrome presented to an outside hospital with mild abdominal and back pain. The initial computed tomography (CT) scan was essentially negative. The repeat CT scan after 1 week of medical therapy was suspicious for a contained rupture of the visceral aorta. She was emergently transferred to the University of Chicago. Emergent aortography confirmed the diagnosis and revealed wide patency of the visceral and renal arteries. Upon exploration, there was obvious rupture of the entire right posterior aortic wall at the level of the celiac axis with a large right retroperitoneal hematoma. Aorto-aortic bypass was performed. The visceral and renal vessels were revascularized using separate jump grafts to this ‘parallel aorta’. The patient tolerated the procedure well and was discharged after 12 days. Pathologic examination of the aortic wall was essentially negative. She is well on follow-up after 20 months. To our knowledge, this is the second reported case of spontaneous contained rupture of the visceral aorta.