A 66-year-old man had presented with nausea and vomiting at a neighboring hospital. Abdominal CT scan revealed a giant aortic abdominal aneurysm accompanied by duodenal obstruction. Y-graft replacement operation was performed in our hospital. Although aortic abdominal aneurysm is often unexpectedly diagnosed by abdominal CT scan, very few cases of aortic abdominal aneurysm have been diagnosed in association with ileac abdominal symptoms; for example vomiting and abdominal pain. We report a case of giant aortic abdominal aneurysm with symptoms of duodenal obstruction, describing pathophysiologic aspects.

The supracardiac type is the most common total anomalous pulmonary venous connection (TAPVC) and is thought to be relatively rarely accompanied by pulmonary venous obstruction. An ascending vertical vein usually passes anterior to the left pulmonary artery, connecting to the brachiocephalic vein without obstruction. Now we report two cases in which the vertical vein passed between the left pulmonary artery and left bronchus with severe pulmonary vein obstruction in neonate. The cases are 12-day and 8-day males both of which were diagnosed mainly by UCT and underwent a succesful emergency operation. The former case with more severe pulmonary congestion than the later, had slower improvement of respiratory function and mild pulmonary hypertension after operation. The ascending vertical veins of both cases are compressed between left pulmonary artery and left main bronchus and then the pulmonary venous obstruction will appear and increase pulmonary hypertension. Resultant distention of the pulmonary artery will cause greater compression of the vertical vein. This will create a “hemodynamic vise.” For these cases, an earlier operation is required at the point of post-operative recovery.