A Case of Superior Mesenteric Artery Occlusion Associated with Aortic Dissection - intestinal Resection Avoided by Combined Stent Graft Treatment and Exploratory Laparoscopy

Abstract

A 45-year-old man presented to an emergency department because of the sudden onset of chest pain. Contrast-enhanced CT showed a Stanford type B aortic dissection extending from the subclavian artery to the bilateral external iliac arteries and creating a dynamic obstruction of the superior mesenteric artery (SMA). After consultation with cardiovascular surgeons, the patient was admitted for conservative treatment, but when a few hours later his abdominal symptoms became progressively more severe, emergency thoracic endovascular aortic repair (TEVAR) and exploratory laparoscopy were performed. Because some parts of the small intestine showed poor contrast on an indocyanine green (ICG) test, we decided on open abdomen management for follow-up purposes and performed a second-look operation 48 hours later. The ischemic intestinal area showed improvement macroscopically, and an ICG test showed improved blood circulation. In the end, we did not resect the small bowel.

TEVAR may be effective in treating some types of SMA occlusion associated with acute aortic dissection. Moreover, exploratory laparoscopy with the use of ICG and OAM may be possible to preserve the intestinal tract if necrosis is suspected.