Successful Anesthetic Management of a Ruptured Aorta Complicating Aortic Dissection following Emergency Cesarean Section: A Case Report

Abstract

A 30-year-old woman who underwent emergency cesarean section due to fetal distress, in our hospital, was admitted to the intensive care unit for close observation because of tachycardia and suspected sepsis. In the intensive care unit, the patient was reintubated and resuscitation started due to unstable hemodynamics and clinical picture of hypovolemic shock and suspected septic shock. Emergency laparotomy, with a multidisciplinary team of obstetric, general, and vascular surgeons, revealed a large retroperitoneal hematoma and a big 3–4 cm long tear with a ruptured infrarenal abdominal aortic wall. Vascular surgeons resected the dissected and ruptured part of the aorta and repaired it with a synthetic graft. The anesthetic management included massive blood and blood product transfusion, invasive hemodynamic monitoring, management of hypotension, hypertension, and transient pulmonary edema due to aortic clamping and massive transfusion. The patient was further managed in the intensive care unit and underwent multiple surgeries due to anterior abdominal wall wound and sequelae. She was finally discharged home, after 66 days, in stable condition.

Keywords

• abdominal aortic dissection
• pregnancy
• anesthesia
• management
• ruptured aortic dissection