Resection or Combined Vascular Resection and Reconstruction Surgery in Patients with Generalized Atherosclerosis and Mesenteric Thrombosis
DOI:
https://doi.org/10.14748/hdb8e830Keywords:
mesenteric thrombosis, atherosclerosis, vascular resection and reconstruction, resectionAbstract
An 84-year-old woman was admitted urgently to the clinic due to lower abdominal pain lasting more than 6 hours. During the diagnostic process, generalized atherosclerosis was identified with thrombosis of the abdominal aorta involving the iliac arteries (Leriche syndrome). Computed tomography (CT) imaging revealed high-grade obstruction of the superior mesenteric artery and complete obstruction with absence of blood flow in the inferior mesenteric artery. After initial resuscitation measures, a combined vascular intervention and resectional surgery were performed. Intraoperatively, ischemia with necrosis of the bowel wall was found in the proximal to middle third of the rectum, along with signs of chronic ischemic changes in the terminal ileum and cecum. A thrombectomy was performed from the abdominal aorta. Revision of the superior mesenteric artery was carried out, followed by an aorto-mesenteric bypass in the region of the inferior mesenteric artery. The necrotic section of the rectum was resected. A non-definitive colostomy (anus praeternaturalis nondefinitivus) was created. Due to irreversible ischemic changes of the terminal ileum and cecum, a right hemicolectomy was performed.
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