Abstract
A 66-year-old woman presented to another hospital with abdominal pain. CT showed CA occlusion, SMA stenosis, and collateral via IMA. After referral to our hospital on suspicion of intestinal necrosis, CT showed increased ascites and ileal wall thickening. Exploratory laparotomy was conducted, however, no evident intestinal necrosis was identified. On postoperative day 5, the patient developed diffuse abdominal pain, CT showed ischemia in the ileum; thus, exploratory laparotomy was performed a second time. Because of ischemic changes in the ileum, and no palpable marginal artery of the right colon, right hemicolectomy without reconstruction was performed, followed by open-abdominal-management. During second-look laparotomy, an endovascular stent was inserted into the IMA to treat IMA stenosis identified by angiography. The intestine was reconstructed, and an ileostomy was placed. Hybrid therapy was thought to be useful in the treatment of an acute exacerbation of chronic mesenteric ischemia.
