HK is a 70 year old male 2 weeks s/p Coronary Artery Bypass Graft (CABG). He also has history of a 6.4 cm Abdominal Aortic Aneurysm (AAA) than needs endovascular repair, as well as history of hypercholesterolemia, and hypertension. He presented to the emergency room with less than 24 hour history of severe epigastric abdominal pain. On examination he was tachycardic at 110-120 beats per minute. His abdomen was rigid with obvious peritoneal signs, guarding and decreased bowel sounds. His WBC was 19 with normal renal functions his CT Abdomen and Pelvis showed free air. He was taken to surgery, explored laparoscopically, and he underwent laparoscopic repair of a perforated duodenal ulcer with closure utilizing the falciform ligament (Grahm’s patch). He was started on a liquid diet POD#2, and discharged home POD#5. At 2 weeks postoperatively he was seen in the office, his drain was removed and he is being scheduled for endovascular AAA repair.

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