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Forum Name: Diseases of the Aorta

Question: Surgery for aortic aneurysm


 Freespirit - Tue Feb 11, 2003 9:15 pm

Hi...I've never posted here before, so hope I'm doing this correctly!

I'm wondering if you can tell me what you would do in this situation. An aortic aneurysm is discovered in an otherwise healthy 77 year old man. It is near one of the kidneys and affecting blood supply to that kidney.
The aneurysm is 8 cm. in diameter. The man's WBC is up, but the source of the infection is unknown, besides the possibility of it being caused from the aneurysm.

Would you wait to do the surgery (to remove that section of the artery) because of an elevated WBC? Or is the need to remove an aneurysm that large more important than an infection?

Thanks for your help!
Teri
 Dr. Yasser Mokhtar - Wed Feb 12, 2003 9:17 pm

User avatar Dear Teri,

An aortic aneursym that large carries the risk of rupture and sudden death if not operated upon. Causes of a high wbcs are many. Infection is just one of them.

My advice at this point is to go ahead and do surgery after making sure that this high white count is not due to infection as an ongoing infection could definitely lead to postoperative complications. If an infection is definitely ruled out and the patient still has an elevated white count then you go ahead and operate and then investigate the cause of the high white count.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 Anonymous - Thu Feb 13, 2003 1:03 pm

Dear Dr. Mokhtar,

Thank you for your insight. Unfortunately, it's a "done deal" and the 77 yr. old man, my father, has passed away. The hospital that discovered the aneurysm didn't do those types of surgeries so had to transport him to a larger hospital. The smaller hospital almost had him flown over, but didn't only because the other hospital doesn't have a heli-pad; that's how urgent they felt it was. They, too, knew that his WBC was up. But, then, he gets to the larger hospital and they say they are going to wait until the WBC goes down. They were thinking in about four days from then. But, two days later, it started to leak so they had to do emergency surgery. When they got inside him, it burst and, of course, was a complete mess in there. So, instead of just being able to do the needed procedure, they had to spend time cleaning all that blood up, first. Of course, this was cutting off his blood supply to his lower body for even longer. They told us 20 minutes, but I have a hard time believing it was only for that long. His kidneys shut down, but they told us that with two or three dialysis treatments, they should start back up. They waited days before starting dialysis and in the meantime, he had a stroke. Right after the stroke, they told us that we might want to change his "code". That he will probably never walk again, etc.... etc..... and that we might want to consider not even starting dialysis! It sounded crazy to us at the time, and still does (!), and we said that we were continuing on. It'd only been two days since his surgery and we weren't going to give up on him, yet. I think they knew more than they were letting on.

So, about the WBC and surgery. I had an appendectomy a couple of years ago. My WBC was up, due to the infection of the appendix. But, they weren't going to take the chance of my appen. bursting so they did the surgery. Isn't this routine procedure?

Another thing with that hospital and those doctors is, it seems that no one, except at the very beginning, was even trying to figure out what the cause of the elevated WBC was. They never even talked about it.....in fact, my mother saw the surgeon before the surgery and I think once afterwards. Then, a doctor took over that was just a general hospital doctor.... and we only saw him when he gave us the "doom and gloom" talk. He wasn't even around before!

So, I don't know... the whole thing seems odd to me.

Can you tell me what other reasons the WBC goes up?

Thanks so much for your help.

Teri
 Dr. Yasser Mokhtar - Thu Feb 13, 2003 9:35 pm

User avatar Dear Teri,

Thank you very much for using our website and thank you very much for your update.

My sympathies about what happened to your dad.

Surgery on an aortic aneurysm is a very hectic situation whether it has leaked or not but of course it becomes more even more hectic if it leaks.

i do not know the exact condition of your father. How much blood he lost? How much blood transfusion did he receive? Is he on a ventilator? Are there any iv medications that he is receiving to keep his blood pressure from going down? Renal failure is not an uncommon complication after aortic aneurysm surgery, what did the kidney specialist have to say about it? Did they say anything about an infection? All these questions and many more need to be answered before really answering you about your dad's condition and the "code status".

However, i can try to shed some light on the causes of high white count. High white count can be caused by:
1. Infection.
2. Certain blood cancers.
3. Certain medications, steroids for example.
4. Stress.
5. Dehydration.
6. Having a heart attack or a stroke.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped and waiting for your update.

Yasser Mokhtar, M.D.

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