Ruptured Deep Femoral Artery Aneurysm Confused with an Incarcerated Inguinal Hernia: a Case of an Elderly Patient

Abstract

Deep femoral artery (DFA) aneurysms are rare. DFA is protected by the adductor canal, which may delay the diagnosis. Then, its early diagnosis may be difficult and it is possible to be misdiagnosis with incarcerated inguinal hernia, which occurs more often in elderly people. We report a very rare case of a treatment of an advanced elderly patient with an isolated ruptured DFA aneurysm that was preoperatively confused with an incarcerated inguinal hernia.

A 97-year-old man was admitted to a neighboring hospital due to a painful mass of the right groin after transient consciousness loss and the patient was diagnosed with right incarcerated inguinal hernia by a nonenhanced computed tomography (CT). Although he was observed for 3 days, he suddenly lost consciousness again with a decrease in blood pressure. Thus, he was referred to our hospital due to the painful pulsatile inguinal mass after resuscitation from shock. As we diagnosed a ruptured DFA aneurysm by an enhanced CT, we emergently performed an excision of the aneurysm with revascularization of the right DFA. The postoperative course was uneventful without ischemic change of the lower leg.

Keywords

rupture - deep femoral artery aneurysm - revascularization - elderly patient - incarcerated inguinal hernia - rehabilitation - femoral artery

• References

• 1 van Bockel JH, Hamming JF. Lower extremity aneurysms. In: Cronenwett JL, Johnston KW. , eds. Rutherford's Vascular Surgery. 7th edition. Philadelphia, PA: Saunders Elsevier; 2010: 1534-1539
• 2 Pappas G, Janes JM, Bernatz PE, Schirger A. Femoral aneurysms. Review of surgical management. JAMA 1964; 190: 489-493
• 3 Levi N, Schroeder TV. Arteriosclerotic femoral artery aneurysms. A short review. J Cardiovasc Surg (Torino) 1997; 38 (04) 335-338
• 4 Harbuzariu C, Duncan AA, Bower TC, Kalra M, Gloviczki P. Profunda femoris artery aneurysms: association with aneurysmal disease and limb ischemia. J Vasc Surg 2008; 47 (01) 31-34 , discussion 34–35
• 5 Posner SR, Wilensky J, Dimick J, Henke PK. A true aneurysm of the profunda femoris artery: a case report and review of the English language literature. Ann Vasc Surg 2004; 18 (06) 740-746
• 6 Rutherford's Vascular Surgery. 6th edition. Philadelphia, PA: Saunders Elsevier; 2005
• 7 Ocke Reis PE, Roever L, Ocke Reis IF. , et al. Endovascular stent grafting of a deep femoral artery pseudoaneurysm. EJVES Short Rep 2016; 33: 5-8
• 8 Pecoraro F, Dinoto E, Bracale UM, Badalamenti G, Farina A, Bajardi G. Symptomatic deep femoral artery pseudoaneurysm endovascular exclusion. Case report and literature review. Ann Vasc Surg 2017; 42: 303.e5-303.e9