Abdominal aortic aneurysm associated with horseshoe kidney

　　Abdominal aortic aneurysms associated with horseshoe kidneys are congenital diseases caused by malformation during embryonic development and are rarely seen in clinical practice. A typical abdominal aortic aneurysm is an expansive mass that pulsates laterally and frontally, with half of the patients accompanied by vascular murmurs.

　　As the condition progresses, abdominal aortic aneurysms associated with horseshoe kidneys can lead to chronic kidney failure. Once the mass ruptures, it can cause massive hemorrhage, complications of hemorrhagic shock, and in severe cases, death.

　　Most patients with abdominal aortic aneurysms associated with horseshoe kidneys have no obvious symptoms, and some patients have urinary system complications caused by horseshoe kidneys. A typical abdominal aortic aneurysm is an expansive mass that pulsates laterally and frontally, with half of the patients accompanied by vascular murmurs. A few patients have compression symptoms, with upper abdominal fullness and discomfort being common. Symptomatic abdominal aortic aneurysms often suggest the need for surgical treatment, and the main symptoms are:

　　1. Pain
　　It is a common symptom before rupture, usually located around the umbilicus and the upper middle abdomen. When the aneurysm invades the lumbar spine, there may be pain in the lumbosacral region. If there is a sudden severe pain in the abdomen or lumbar region in recent days, it often indicates that the mass is about to rupture.

　　2. Rupture
　　Patients with acute rupture present with sudden severe pain in the lower back and lumbar region, accompanied by shock symptoms, and may even die before admission. If it breaks into the peritoneal cavity, bleeding is localized to form a hematoma. Abdominal pain and hemorrhagic shock can last for several hours or days, but there is a possibility of re-breaking into the peritoneal cavity and causing death.

　　The etiology of abdominal aortic aneurysms associated with horseshoe kidneys is due to malformation during embryonic development, so it cannot be prevented directly. Early detection, early diagnosis, and early treatment are of great significance for indirect prevention of the disease. Regular checks during pregnancy should be done, and ultrasound can detect abnormalities early. If the child shows a tendency of developmental abnormalities, chromosomal screening should be done in a timely manner, and if confirmed, artificial abortion should be performed promptly to avoid the birth of children with the disease.

　　Most patients with abdominal aortic aneurysms associated with horseshoe kidneys have no obvious symptoms, and diagnosis depends on related examinations. The main examination methods in clinical practice are as follows:
　　1. Abdominal ultrasound It can be found that the abdominal aortic aneurysm and the inferior pole of the kidney in front of it are close to the midline and the superior pole is far from the midline, and the isthmus connected to the inferior pole of the kidney shows hypoechoic characteristics.
　　2. CT examination It is visible that the malformed kidney is crossing over the abdominal aortic aneurysm in front, and the local condition of the abdominal aortic aneurysm can be understood.
　　3. Intravenous pyelography The renal calyces and renal pelvis are visible, and the long axis of the ureter is in the shape of an 'inverted eight', and it is often due to ureteral torsion or compression by abnormal blood vessels that leads to hydronephrosis.
　　4. Aortography Not only can it understand the range of abdominal aortic aneurysm and the condition of the organs involved, but it is also important to understand the abnormal supply artery of the horseshoe kidney, which is an indispensable examination.

　　Patients with abdominal aortic aneurysm with horseshoe kidney should limit the intake of carbohydrates and eat less food high in oxalates. In addition, some dietary therapies can be tried, detailed as follows:

　　1. Silver ear and rock sugar nourishing Yin porridge
　　Ingredients: Silver ear 10 grams, egg 1, rock sugar 60 grams, lard an appropriate amount.
　　Method: Remove the root and impurities from the soaked silver ear, pick out impurities, rinse clean, add an appropriate amount of water, bring to a boil over high heat, then simmer over low heat until the silver ear is soft, add rock sugar, stir until dissolved. Take the egg white and mix with a little water, stir well, add to the pot, bring to a boil over low heat, and add a little lard before serving.

　　2. Lycium barbarum porridge
　　Ingredients: Fresh leaves of Lycium barbarum 250 grams, an appropriate amount of rice.
　　Method: Select and clean the leaves of Lycium barbarum, wash the rice, add an appropriate amount of water, and cook over low heat until soft.

　　The main method of treating abdominal aortic aneurysm in patients with horseshoe kidney is surgery. The abdominal median incision from the xiphoid process to the symphysis pubis is used during the operation, similar to the usual abdominal aortic aneurysm, and the neck of the aneurysm can be safely dissected above the isthmus of the horseshoe kidney. Attention should be paid not to damage the bilateral renal pelvis. The horseshoe kidney can be pulled to fully expose the aortic bifurcation and the common iliac artery. If the isthmus is a fibrous structure, it can be cut to facilitate exposure, and the abdominal aortic aneurysm is cut after blocking the proximal and distal ends of the abdominal aortic aneurysm.
　　Anastomosis of the aorta and the artificial blood vessel is performed within the abdominal aortic aneurysm wall. If there is an abnormal renal artery originating from the abdominal aortic aneurysm, it should be anastomosed on the artificial blood vessel with a window. The abnormal renal small artery branches near the aortic bifurcation should also be fully protected, and reconstruction should be performed if necessary, finally wrapping the artificial blood vessel with the aneurysm outer wall.
　　During the operation, it should be noted that the isthmus containing the renal parenchyma should be avoided from being cut, because cutting the isthmus often leads to bleeding, renal infarction, and possible urinary leakage due to infection, causing fatal infection of the artificial blood vessel. Postoperative antibiotics should be used to prevent infection, and kidney function should be monitored and improved.