Early Abdominal Closure Achieved through Retroperitoneal Hematoma Evacuation after Endovascular Aneurysm Repair and Open Abdominal Management for a Ruptured Aortic Aneurysm

Tomoki Tamura＊	Hidetomi Takahashi＊	Rihito Horikoshi＊
Yusuke Irisawa＊	Tetsuya Horai＊

（Department of Cardiovascular Surgery, Central Hospital of the National Center for Global Health and Medicine＊, Tokyo, Japan）

Abdominal compartment syndrome（ACS）is an important postoperative complication of endovascular aneurysm repair（EVAR）for ruptured abdominal aortic aneurysms（rAAA). Open abdominal management（OAM）has been reported to be effective in EVAR;however, only a limited number of reports are available on when and how to close the abdomen. Here we report a case of early abdominal wall closure achieved through the combined use of retroperitoneal hematoma evacuation after EVAR and OAM for rAAA. The patient was a 79-year-old woman who underwent EVAR for rAAA on an emergency basis. She developed ACS after EVAR and underwent OAM. Four days after surgery, a decrease in intraabdominal pressure was confirmed, and subsequent contrast-enhanced computed tomography revealed the absence of an endoleak;retroperitoneal hematoma evacuation was performed, during which the abdominal wall was closed. The postoperative course was good, and the patient was discharged. Early closure of the abdomen may be possible by concomitant retroperitoneal hematoma evacuation after EVAR and OAM for rAAA.

 

Jpn. J. Cardiovasc. Surg. 49:81-85（2020）

Keywords：ruptured abdominal aortic aneurysm;abdominal compartment syndrome;open abdominal management;retroperitoneal hematoma evacuation