Decompressive Laparotomy for Abdominal Compartment Syndrome Following Transcatheter Arterial Embolization of a Ruptured Splenic Artery Aneurysm : Report of A Case

Abstract

Rupture of a splenic artery aneurysm, one of the most common visceral aneurysms, is relatively rare and potentially fatal. To date, endovascular treatment of ruptured visceral artery aneurysms is being increasingly performed. Abdominal compartment syndrome (ACS) is a known complication of abdominal aortic aneurysms and can occur with endovascular treatment. We herein report on a case of decompressive laparotomy for ACS following endovascular treatment of a ruptured splenic artery aneurysm. A 49-year-old man presented to our hospital with abdominal distension and subsequent hemorrhagic shock. CT showed a ruptured splenic artery aneurysm with intra-abdominal hemorrhage. We performed transcatheter arterial embolization (TAE) of the splenic artery with a massive blood transfusion and his hemodynamics stabilized. However, he complained of dyspnea and abdominal distension 12 hours after the TAE and intra-abdominal pressure measured by the trans-bladder technique was 35 mmHg. We then diagnosed him as having ACS. The patient underwent an emergency decompressive laparotomy which revealed 3,700 g of hematoma in the peritoneal cavity without the prophylactic use of open abdominal management. His postoperative course was uneventful. Immediate decompressive laparotomy should be performed in cases of overt ACS following endovascular treatment for ruptured visceral artery aneurysms.