Abstract
Ruptured abdominal aortic aneurysm remains one of the high mortality diseases. A common treatment for this condition is open repair, but recently this treatment is increasingly reported as endovascular repair (EVAR). The main problem following EVAR is a pathogenesis abdominal compartment syndrome (ACS) and continued hemorrhage for a variety of endoleak. We report a case of EVAR and damage control surgery (DCS) for free wall ruptured abdominal aortic aneurysm. A 78-year-old male with unconsciousness and abdominal pains was admitted to our hospital by a helicopter. A computed tomography scan revealed the retroperitoneal hematoma around abdominal aortic aneurysm. Surgical treatment consisted of emergent EVAR. Anesthesia induction brought about a reduction in blood pressure and abdominal distention, thus we suspected free wall rupture. Open abdominal surgery was performed for ACS after EVAR without endoleak. Because of excessive bleeding and non-identifiable hemorrhagic spot, a hemostasis was of great difficulty. Hence we employed DCS including the abdominal gauze-packing and temporary closure. After the operation he was managed by combined modality therapy in intensive-care unit. Two days later we performed second look operation. Because of confirmed hemostasis we performed de-packing and permanet closure. The patient slowly recovered and changed hospital on the 96nd hospital day.
