Hi, this has been a useful site for me and I thought I would share some notes about our current ordeal. My dad (age 74) is currently in ICU in his Missouri hometown after suffering a ruptured AAA on Dec. 27, 2000. He and mom live near a good hospital and he was diagnosed correctly in the ER and gotten into surgery extremely quickly with an experienced thoracic specialist, which I'm sure saved his life. I don't know the size of his undiagnosed AAA, but it was large, and he had not had much in the way of symptoms other than some nonspecific abdominal pains before he passed out at home.
On Dec. 29 he had exploratory surgery to ascertain the condition of his colon -- luckily it was OK -- so they removed his gallbladder and sewed him back up. In early January they began attempting to wean him from the ventilator, and this went well until he contracted pneumonia, which set him back by about 3 weeks. A trach was inserted, as well as a feeding tube and tube to remove stomach acid. By late January the pneumonia had dissipated and the feeding and acid tubes had been removed and he was no longer using the ventilator to breathe, though the nurses were still suctioning him occasionally through the trach. He then managed to remove his own trach at some point on Feb. 2 when he was alone and not restrained. Since he was already off the ventilator they did not reinsert it. His kidney function is also not optimal and he has been on 3x a week dialysis for about a month -- not sure yet whether this is a permanent or temporary condition.
On Feb. 3 he had an episode of significant bleeding from the bowel. After a couple of endoscopies an esophageal ulcer was diagnosed, but it stopped bleeding on its own. He was treated with antacids and the nurses were told to have him sitting up (rather than lying down) as much as possible. He was only on the vent for a couple hours after this incident. The theory is that the ulcer was caused by stomach acid reflux during weeks of being flat on his back.
Dad began talking and eating during the week of Feb. 5. He was relatively lucid part of the time, but by the end of the week he appeared to be succumbing rapidly to sleep deprivation and ICU psychosis, and we were beginning to consult with a psych specialist to work on those issues. Dad was also able to take a few steps with a walker.
They were getting ready to move Dad to a step-down unit in the theory that this would be a better place to work on his walking as well as the psych issues, when he had a catastrophic bleeding incident on Feb. 9. The ulcer had opened up again and eaten through to an artery in the esophagus. We were told he would need emergency surgery and were sure he would not survive, but the GI doc managed to use the endoscope and cauterize the ulcer to stop the bleeding without having to resort to the surgery. Many of the IV tubes dad had had removed went back in, as did the ventilator (but not a trach). No feeding or GI tubes yet, and after discussion with the GI doc, who suggested using a new tube to pump a stronger anti-ulcer med into dad's stomach, we declined. (He acknowledged that inserting the tube meant risking dislodging the clot over the ulcer, which we weren't willing to risk.) Antacids are still being administered via IV.
As of today (Feb. 13) Dad is still on the ventilator and heavily sedated. His heart is strong and his BP seems stable, but we have no idea how long the sedation and vent will be necessary, how long the ulcer will take to heal, or whether it will "blow" again and ultimately kill him. Mom has said her "last goodbyes" to him about 4 times and needless to say is exhausted by the ordeal.
I am heartened by the truly amazing stories of survival on this site... especially stories of people who spent months in the hospital enduring multiple complications and still eventually survived. We pray that if it were Dad's fate to die, it would have happened more quickly. Each day is filled with anxiety and hope, and everyone jumps every time the phone rings. We pray that Dad will recover, or if this is not to be, that he will not have to suffer much longer. We are grateful that he seems to be getting excellent care and that his many specialists really seem to know what they're doing.
I hope to be able to post a follow-up in a few months with a happy ending.
Update 3 Jun 2001
Dad finally got out of the hospital in late April almost four months to the day after his ruptured AAA. He had initially been discharged from ICU in late March, after spending more than a month recovering from the effects of the bleeding ulcer. But he contracted pneumonia in the step-down unit, and had to go BACK to ICU for another 10 days. Then he had another short round in the step-down unit, then more than a week in rehab before finally getting OK'd to come home. He had trouble getting off the trach after many years of being a smoker, and we were all getting extremely frustrated, but success finally came. It was a red-letter day not only for mom and dad but also for many of the hospital staff when he was discharged. He has earned the nickname "miracle man" from the nursing team.
Unfortunately (or actually, fortunately, probably), before he was discharged he had some stool bleeding and a colonoscopy uncovered a couple of polyps -- and something bigger. The biopsy was inconclusive but chances are good that this is early-stage colorectal cancer, so he has to have another abdominal surgery on June 18 to remove the growth. We are not happy about another round of surgery, and obviously we pray for a complication-free result this time! This is a very curable cancer if caught early, so it all may turn out to have been a blessing in the long run. If the cancer is malignant he probably faces some chemotherapy, but the growth is extremely small and is confined to the colon so we hope for a good result.
The true wonder of the situation is that despite all his troubles (ruptured AAA, two bouts of ventilator-induced pneumonia, and a catastrophic bleeding incident from an esophageal ulcer), he came home weak but otherwise pretty much whole. No bowel complications from the AAA, no leg or foot troubles to speak of, and his kidneys miraculously recovered adequate functioning after more than eight weeks on dialysis. This almost never happens (only twice in 20 years of observation of post-AAA patients by his surgeon).
He was prayed for by hundreds of people worldwide, many of whom had never met him, courtesy of the power of the Internet. We are convinced of the mysterious efficacy of prayer, and we hope he will have more years of enjoying his grandchildren and his cronies, as soon as the colorectal cancer gets taken care of. He complains of feeling tired (no surprise!) and also has a sore bottom from lingering effects of a healed-over bedsore. But I know he can't feel that terrible because last week when I talked to him he had just come in the house after mowing the lawn on a riding mower!
His case is really an anomaly, but I hope that by posting the update on the site, people will have hope that even after very severe cases of ruptured AAA and post-op complications, miracles can happen.
Update 30 Oct 2001
Dad was operated on for colon cancer in mid-June. The operation was a complete success and the pathology report was encouraging. About 12 inches of colon was removed. Due to the size and localized nature of the cancer, Dad did not need radiation or chemotherapy, though he will have to have periodic colonoscopies to make sure nothing new is going on. When they did a post-surgical CAT scan about a month later they saw something on his liver that the radiologist is pretty sure is a benign cyst. He is to go back for a follow-up cat scan in a few weeks but we don't anticipate any problems.
He continues to do very well. He complains of many things (not surprising for a man of his age who has been through such ordeals), but lives a reasonably "normal" life as far as I can tell. He has gained weight and strength and can now do all the tasks he formerly did around the house, including mowing the lawn of his hilly yard. He had been riding an exercise bike faithfully till last month when he strained a leg muscle changing the tire of his sister's car! (He of course was convinced that he had a blood clot in his leg or something else dire - a little paranoia after his recent medical history is inevitable I suppose - but it turned out to be plain old muscle damage.
Dad celebrated his 75th birthday in September. Back in January I'd have been very skeptical that he was ever going to achieve that milestone. Miracles really do happen, and I hope our report will give some encouragement to those who are also experiencing the trauma and likely post-surgical complications of ruptured AAA. Dad's case is unusual but not unique. Prayer and a strong will to live can sometimes lead to very surprising conclusions, and results that defy all the odds.