Abstract
We encountered a 77-year-old man who developed wrapping sac enlargement and rupture 10 years after vascular graft replacement for an abdominal aortic aneurysm. He had undergone aortic replacement with a bifurcated woven Dacron graft (20×10 mm). The wrapping aneurysm sac began to enlarge 1 year after surgery. Although computed tomography (CT) suggested a high-density hematoma, the exact source of bleeding could not be identified by CT, magnetic resonance imaging, or abdominal ultrasonography. The wrapping aneurysm sac enlarged by approximately 4 mm per year, and ruptured 10 years after the initial surgery. No hypotension or abdominal pain occurred at the time of rupture, which was incidentally detected by CT during a detailed evaluation of other diseases. Intraoperatively, a hematoma was observed in the left retroperitoneal space, and the wrapping aneurysm sac contained a small amount of old thrombus and a large amount of fresh thrombus. No anastomotic aneurysm or damage to the vascular graft was observed, and no backflow of blood occurred from the inferior mesenteric or lumbar artery. There was only diffuse oozing from the entire aneurysm sac. The oozing was arrested, and, after the resection of as much of the aneurysm sac as possible, the surgery was completed by plicating the remaining aneurysm sac. Herein, we report this very rare case of wrapping aneurysm sac enlargement and rupture due to oozing.
