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Abdominal compartment syndrome after endovascular repair for ruptured abdominal aortic aneurysm leads to acute intestinal necrosis

View Article: PubMed Central - PubMed

ABSTRACT

Introduction:: Abdominal compartment syndrome (ACS) after endovascular repair (EVAR) of rupture abdominal aortic aneurysm (rAAA) is a rare emergency situation, which has a high mortality. However, the progression of ACS is rapid and the diagnosis is usually been delayed, which increase the difficulties in treatment and affect the prognosis. We describe a case of a sever complication (acute intestinal necrosis) resulting from ACS after endovascular repair of rAAA.

Clinical finding:: An elderly man, 81 years old, complained a sudden lower abdominal and back pain without any predisposing cause. He had a history of hypertension for 20 years without any regular anti-hypertensive therapy. Physical Examination revealed that the blood pressure was 89/54 mmHg, pulse was 120/min, oxygen saturation was 91%. The abdominal ultrasound and the CTA (computed tomography angiography) scan revealed a rAAA. Emergency EVAR under general anesthesia was performed for this patient.

Diagnosis:: Fourteen hours after endovascular repair, sudden decreased of blood pressure (70/50 mmHg) and oxygen saturation (70%) was observed. ACS or bleeding of retroperitoneal space was diagnosed.

Interventions:: Abdominal laparotomy was immediately performed. ACS was verified and a severe complication (acute intestinal necrosis) was observed, intestinal resection was performed for this patient.

Outcomes:: Unfortunately, this patient died after operation because of multi-organ failure in a very short period, which is very rare regarding to this condition. Surgical pathology, diagnosis and management were discussed.

Conclusion:: ACS was occurred with a severe complication (acute intestinal necrosis) in a very short period, which is very rare regarding to this condition after EVAR, it reminds us the severe result of ACS and more methods to prevent it happened after surgical management.

No MeSH data available.


Related in: MedlinePlus

Angiography after EVAR, no endoleak was observed. EVAR = endovascular aneurysm repair.
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Figure 2: Angiography after EVAR, no endoleak was observed. EVAR = endovascular aneurysm repair.

Mentions: Considering the hemorrhagic shock and poor basic condition of these patients, the emergency EVAR was immediately performed under general anesthesia. Angiography verified the contrast outflow from left side of aneurysm and there was calcification of abdominal aorta wall with an angulated aneurysmal neck. A Medtronic bifurcated stent was implanted through bilateral common femoral artery and implanted just below the orifice of renal artery to cover the aneurysm. Re-examination of angiograph showed that stent was accurately located just below renal artery with aneurysm completely covered by stent, there was no endoleak observed, whereas the vital signs for this patient become stable (blood pressure:105/70 mm Hg, pulse: 100/min, oxygen saturation: 96%). The procedure of EVAR was successful (Fig. 2).


Abdominal compartment syndrome after endovascular repair for ruptured abdominal aortic aneurysm leads to acute intestinal necrosis
Angiography after EVAR, no endoleak was observed. EVAR = endovascular aneurysm repair.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5134860&req=5

Figure 2: Angiography after EVAR, no endoleak was observed. EVAR = endovascular aneurysm repair.
Mentions: Considering the hemorrhagic shock and poor basic condition of these patients, the emergency EVAR was immediately performed under general anesthesia. Angiography verified the contrast outflow from left side of aneurysm and there was calcification of abdominal aorta wall with an angulated aneurysmal neck. A Medtronic bifurcated stent was implanted through bilateral common femoral artery and implanted just below the orifice of renal artery to cover the aneurysm. Re-examination of angiograph showed that stent was accurately located just below renal artery with aneurysm completely covered by stent, there was no endoleak observed, whereas the vital signs for this patient become stable (blood pressure:105/70 mm Hg, pulse: 100/min, oxygen saturation: 96%). The procedure of EVAR was successful (Fig. 2).

View Article: PubMed Central - PubMed

ABSTRACT

Introduction:: Abdominal compartment syndrome (ACS) after endovascular repair (EVAR) of rupture abdominal aortic aneurysm (rAAA) is a rare emergency situation, which has a high mortality. However, the progression of ACS is rapid and the diagnosis is usually been delayed, which increase the difficulties in treatment and affect the prognosis. We describe a case of a sever complication (acute intestinal necrosis) resulting from ACS after endovascular repair of rAAA.

Clinical finding:: An elderly man, 81 years old, complained a sudden lower abdominal and back pain without any predisposing cause. He had a history of hypertension for 20 years without any regular anti-hypertensive therapy. Physical Examination revealed that the blood pressure was 89/54 mmHg, pulse was 120/min, oxygen saturation was 91%. The abdominal ultrasound and the CTA (computed tomography angiography) scan revealed a rAAA. Emergency EVAR under general anesthesia was performed for this patient.

Diagnosis:: Fourteen hours after endovascular repair, sudden decreased of blood pressure (70/50 mmHg) and oxygen saturation (70%) was observed. ACS or bleeding of retroperitoneal space was diagnosed.

Interventions:: Abdominal laparotomy was immediately performed. ACS was verified and a severe complication (acute intestinal necrosis) was observed, intestinal resection was performed for this patient.

Outcomes:: Unfortunately, this patient died after operation because of multi-organ failure in a very short period, which is very rare regarding to this condition. Surgical pathology, diagnosis and management were discussed.

Conclusion:: ACS was occurred with a severe complication (acute intestinal necrosis) in a very short period, which is very rare regarding to this condition after EVAR, it reminds us the severe result of ACS and more methods to prevent it happened after surgical management.

No MeSH data available.


Related in: MedlinePlus