Non-Surgical Pneumoperitoneum After Fenestrated Endovascular Aortic Repair- Case Report

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Gastroenterology

Background:

• Post-operative pneumoperitoneum typically suggests gastrointestinal perforation.
• Non-surgical causes, including mechanical ventilation, are less common but recognized.
• Fenestrated endovascular aortic repair (fEVAR) is an advanced treatment for complex aortic aneurysms.

Purpose of the Study:

• To report a rare case of non-surgical pneumoperitoneum following fEVAR.
• To highlight the importance of considering alternative etiologies beyond gastrointestinal perforation.
• To discuss the diagnostic and management implications in the post-fEVAR setting.

Main Methods:

• A case report of a 79-year-old female undergoing fEVAR for a juxtarenal abdominal aortic aneurysm.
• Preoperative computed tomography angiography (CTA) identified a diaphragmatic hernia.
• Postoperative imaging (CTA) revealed pneumoperitoneum and pneumomediastinum; exploratory laparoscopy and gastro-duodenoscopy were performed.

Main Results:

• Successful fEVAR was performed, but significant pneumoperitoneum and pneumomediastinum were detected postoperatively.
• No evidence of gastrointestinal perforation was found during exploratory laparoscopy and gastro-duodenoscopy.
• The patient presented with mild abdominal tenderness and elevated C-reactive protein (CRP).

Conclusions:

• Non-surgical pneumoperitoneum can occur after fEVAR, potentially linked to mechanical ventilation and alveolar injury.
• Clinical context and imaging findings are crucial for accurate diagnosis.
• An initial 'watch and wait' strategy may be appropriate, avoiding unnecessary surgical intervention.