Duodenal Obstruction after Endovascular Repair of a Ruptured Abdominal Aorta Aneurysm

Endovascular repair has become the most frequent approach in the management of the ruptured infra-renal abdominal aorta aneurysm. When managing the ruptured patient with a significant retroperitoneal hematoma, abdominal compartment syndrome is often a consideration. Duodenal obstruction from the hematoma is rare and not typically a consideration. In the case of our patient, the intra-abdominal pressures were successfully managed conservatively. The large retroperitoneal hematoma, however, encased and obstructed the duodenum ultimately requiring a gastrojejunostomy. Similar rare cases of duodenal obstruction have been reported after open aortic repairs. We have not identified other cases in the literature of duodenal obstruction after endovascular management of a ruptured abdominal aorta aneurysm. We want to raise awareness to the possibility. In our opinion, conservative management would still be the preferred course of action, even if surgical management was ultimately required for the duodenal obstruction, as it reduces the initial insult in the patient with the aneurysmal rupture.