A Case of Intraperitoneal Bleeding from Rupture of a Middle Colic Artery Aneurysm Treated by Direct Surgical Ligation Using REBOA

Abstract

A 55-year-old man presented to our hospital with abdominal pain. He was diagnosed as being in shock upon arrival at the hospital. Abdominal CT and angiography revealed a mesenteric hematoma formed from the ruptured middle colic artery aneurysm. We performed IVR as the patient was in hemorrhagic shock. However, during the IVR, his blood pressure decreased at an alarming rate. Consequently, as we decided to perform direct surgical ligation of the ruptured aneurysm, we performed REBOA (resuscitative endovascular balloon occlusion of the aorta) and clumped the ascending aorta partially before the surgery. This enabled us to control the bleeding before and during surgery. REBOA has been used as a hemostatic device for traumatic hemorrhage in emergency situations, but is also a useful tool for non-traumatic hemorrhage. In this report, we present a case of intraperitoneal bleeding in which we successfully used REBOA to control the bleeding before and during surgery, along with a review of the relevant literature.