Abstract
The patient was a man in his seventies who was diagnosed as having an abdominal aortic aneurysm and underwent endovascular aneurysm repair (EVAR). The patient developed abdominal pain and anal bleeding 4 days after EVAR. As intestinal necrosis and perforation were not evident on imaging findings, conservative treatment was employed. On the 6th day after EVAR the abdominal pain was abruptly aggravated and free air was identified in the abdominal cavity. Emergency laparotomy was thus performed. Intraoperative findings included discontinuous necrosis in the intestinal wall from the jejunum to the ileum and a perforated part. Extensive resection of the small intestine by about 300 cm in length was performed. Histopathological study showed no thrombi and occlusion at the mesenteric artery, and non-occlusive mesenteric ischemia (NOMI) was the most likely diagnosis. After the operation the patient developed pneumonia and an infectious aortic aneurysm and died of multiple organ failure on the 57th postoperative day.
EVAR is less invasive than the conventional operations, however, owing to its less invasiveness, it is apt to be used even for high risk cases. In treating abdominal pain occurring abruptly after EVAR, it is important to consider a possible onset of NOMI and to make fast determination of therapeutic guideline.
