A Case of Intestinal Tract Preservation by Hybrid Surgery 24 Hours After Onset in a Case of Superior Mesenteric Artery Embolism

Abstract

Superior mesenteric artery embolism (SMA embolism) is often missed in the early stages of the disease due to the lack of specific findings. We report a case in which the intestinal tract was successfully preserved by hybrid surgery, even though about 24 hours had passed since the onset of the disease. The patient was a 72-year-old man who had been off anticoagulants after orthopedic surgery. On day X-1, he complained of sudden abdominal pain, but there were no remarkable findings and he was kept under observation. On day X, bloody stools were observed, SMA embolism was diagnosed based on the results of imaging examinations, and hybrid surgery was performed. Angiography showed that intestinal blood flow was maintained via the marginal artery, intraperitoneal observation revealed that total necrosis had not yet occurred, and the SMA obstruction was released by retrieval of the thrombus. Following thrombus retrieval, the color of the intestinal tract gradually improved, indicating the restoration of perfusion, and bowel resection was deemed unnecessary. Hybrid surgery enables real-time assessment of the intestinal viability, facilitating appropriate intraoperative decision-making and potentially improving the patient outcomes.