Abdominal pain and hemoperitoneum: Sole presenting symptoms for "Leaking AAA" after endovascular repair

Purpose: To describe an unusual presentation of impending aortic endograft rupture and successful endovascular rescue. Case Report: A 77-year-old man with an enlarging aortic aneurysm was treate d with a Talent bifurcated endoprosthesis; a moderate endoleak that appeare d to be related to either proximal or distal fixation sites was noted in th e body of the aneurysm. The patient was observed for 1 month, and repeat im aging demonstrated persistent endoleak without major increase in the aneury sm diameter. Another examination was scheduled for 3 months hence, but, 2 m onths later, the patient presented with abdominal pain and a hemoperitoneum . A proximal extension cuff resolved the leak and led to resolution of the hemoperitoneum. Conclusions: A leaking aneurysm can be repaired using endovascular techniqu es in patients with an existing endograft. The need for frequent imaging su rveillance of patients with endoleak is underscored.