Emergency hybrid repair for late ruptured thoracoabdominal aortic dissection after previous aortic repair complicated by colonic perforation and gastric bleeding: a case report

Abstract Introduction Late aortic rupture occurring 9 years after Sun’s procedure represents a rare long-term complication. Although hybrid repair may serve as a rescue strategy for such patients, severe postoperative gastrointestinal complications present major therapeutic challenges, and reports of survival after this catastrophic event remain scarce. This case highlights the risk of late-rupture after Sun’s procedure and shares multidisciplinary management considerations for comparable aortic pathology. Case presentation We report the case of a 48-year-old East Asian male patient presenting with acute back pain 9 years after surgical repair of Stanford type A aortic dissection (AD). Computed tomography angiography (CTA) revealed rupture of a distal thoracoabdominal AD, massive left hemothorax, and anatomical involvement of multiple visceral arterial branches. The patient was diagnosed with ruptured AD and underwent emergent hybrid repair consisting of thoracoabdominal aortic stenting with retrograde four-vessel visceral debranching. His postoperative course was complicated by hemorrhagic shock, acute kidney injury (AKI), and sigmoid colon perforation on postoperative day 21 together with gastric bleeding from stress-related mucosal injury, necessitating emergency exploratory laparotomy and subsequent gastrointestinal surgery. He also developed Enterococcus faecium bacteremia and surgical site infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). After 84 days of multidisciplinary intensive care, the patient survived and was transferred to a rehabilitation facility. He was finally discharged to home after a 75-day rehabilitation period. Conclusions This single case describes survival after emergency hybrid repair of ruptured thoracoabdominal AD 9 years after previous aortic surgery. The postoperative course included hemorrhagic shock, AKI, colonic ischemia progressing to sigmoid perforation, and bleeding gastric ulcers. The mechanism of late rupture and the causes of the gastrointestinal complications remain uncertain. The case emphasizes repeated assessment of gastrointestinal deterioration after complex aortic intervention and continued surveillance of residual aortic disease.