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A 75-year-old woman was admitted to our hospital with a chief complaint of distinct abdominal pain. At first we suspected rupture of an abdominal aortic aneurysm because of the presence of a pulsatile abdominal mass. However, the computed tomography with contrast enhancement revealed an infrarenal abdominal aortic aneurysm with marked thickening of the aneurysmal wall (mantle core sign) and left hydronephrosis. Left hydronephrosis was caused by rigid adherence of the adjacent left ureter to the aneurysmal wall. We diagnosed an unruptured inflammatory abdominal aortic aneurysm and performed elective surgical replacement of the abdominal aorta using a Y-shaped woven Dacron graft. We avoided urological intervention for the hydronephrosis to prevent injury to the ureter because marked thickening of the aneurysmal wall and rigid adherence of adjacent structures decrease after surgery. Recognition of abdominal aortic aneurysm with careful diagnostic management before surgery can help determine the operative strategy.

A Successful Surgical Case: Inflammatory Abdominal Aortic Aneurysm with Distinct Abdominal Pain, Is It Really an Aortic Rupture?