Abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm: A case report and literature review

Abstract

Background: Abdominal compartment syndrome (ACS) arises in approximately 7% after ruptured abdominal aortic aneurysm (RAAA) treatment. Decompressive laparotomy is a satisfactory way to treat ACS. The problem is deciding when to complete abdominal closure with appropriate alternative treatments.[1]
 Methods: This is a case report of successful ACS treatment following RAAA intervention at Ho Chi Minh University Hospital of Medicine and Pharmacy with a literature review.
 Clinical case: A 61-year-old male patient was hospitalized for abdominal pain. Computed tomography angiography demonstrated RAAA. He underwent the emergency endovascular repair of ruptured aneurysms (rEVAR). At 30 minutes post-intervention, the patient's abdomen was distended following intraabdominal hypertension measured via bladder catheter. Within ACS diagnosing, emergency decompressive laparoscopy was performed. The abdominal wall was left open and covered with a sterile nylon cover. The fascial closure was performed on the sixth postoperative day with the support of vacuum-assisted wound closure (VAC) and mesh-mediated fascial traction. On the 27th postoperative day, the wound could close completely, and the patient could be discharged successfully.
 Conclusion: A bladder pressure is required to monitor intraabdominal pressure postoperatively after decompressive laparotomy. Delayed fascial closure is appropriate with supporting VAC until total abdominal closure.