Refractory abdominal compartment syndrome secondary to ruptured abdominal aortic aneurysm treated with total colectomy and upper rectal resection: A case report and literature review

RATIONALE: Ruptured abdominal aortic aneurysm (RAAA) is a critical condition often complicated by multiple organ dysfunction syndrome (MODS), which can significantly impede recovery following surgical intervention. Abdominal compartment syndrome (ACS) is a widely recognized but highly lethal postoperative complication. PATIENT CONCERNS: A 69-year-old male presented with acute abdominal pain and hemorrhagic shock. DIAGNOSES: RAAA with active extravasation was confirmed, and following surgical repair, the patient developed MODS, including hepatorenal failure and acute respiratory distress syndrome. Twenty-one days postoperatively, secondary ACS led to colonic ischemia. INTERVENTIONS: The patient was managed using staged surgical interventions, including decompressive laparotomy, negative pressure wound therapy systems, and definitive total colectomy with upper rectal resection due to refractory ACS characterized by transmural colonic necrosis. OUTCOMES: The patient showed significant recovery and was discharged after 81 days of hospitalization. At 1-month follow-up, he reported normal oral intake and no recurrence of major complications. LESSONS: This case illustrates the effectiveness of a phased damage control strategy in managing high-risk RAAA patients, demonstrating that early prediction, timely intervention, and multidisciplinary care can significantly improve survival outcomes.