Intermittent Claudication Secondary to Idiopathic Fibrous Retroperitonitis

Abstract

In the case of idiopathic fibrous retroperitonitis presented, the only symptoms were those of arterial insufficiency of the lower limbs and testicular and inguinal pain of uncertain origin. Relief of claudication and return of normal pulsations were achieved after surgical lysis of the common iliac arteries and the terminal segment of the aorta. Numerous reports in the literature indicate that idiopathic fibrous retroperitonitis is not rare but retroperitoneal arterial obstruction by the fibrous plaque is apparently unusual, and intermittent claudication without urinary symptoms is unique. Idiopathic fibrous retroperitonitis, therefore, should be included in the differential diagnosis of the causes of intermittent claudication. Although the aortogram may not permit differentiation of arteriosclerosis obliterans from external compression of the aorta by this fibrosing process, the excretory urogram should be helpful in making or excluding the diagnosis. Treatment is primarily surgical with thorough excision of the fibrous mass and with ureteral transplantation; vascular resection or bypass grafting is not necessary. Advisability of postoperative roentgen and adrenal corticoid therapy is not clearly established.