Abstract
We report a case of a damage control technique for life-threatening intraoperative hemorrhagic shock in the urgent aortoenteric fistula surgery. The patient was a 79-year-old male with a history of aortic graft replacement for infrarenal abdominal aortic aneurysm 12 years ago was brought to the emergency room with massive hematemesis and diagnosed of aortoenteric fistula between the proximal anastomosis and the duodenum by CT and duodenoscopy. The previous proximal anastomosis was replaced with a new Dacron graft. Four hours after the beginning of the urgent surgery, hemorrhage from around the anastomosis became uncontrollable due to recalcitrant coagulopathy. As hemorrhagic shock and metabolic acidosis additionally were developed, employed was damage control technique including the abdominal packing and temporary closure. Re-laparotomy was performed after 24 hours of resuscitation with rewarming and correction of coagulopathy in the intensive care unit, indicated that hemostasis was achieved, and also revealed there was another mural necrosis near the previously repaired fistula of the duodenum, so it was resected and repaired by direct suture closure. The patient tolerated well the procedure and discharged on the 62nd hospital day.
