Abstract
A 66-year-old man visited with chief complaints including abdominal pain and blood in the stool. He was diagnosed with superior mesenteric artery thrombosis not involving intestinal necrosis, and conservative treatment was attempted, but exacerbation of his abdominal symptoms on hospital day 2 forced an emergency surgical procedure. About 50 cm of necrotic small intestine was partially resected, and the stump was lifted outside the abdominal wall as a small intestine fistula in a “second-look operation” strategy. On postoperative day 12, about 70 cm of small intestine was additionally excised, and the small intestine fistula was closed. After the second surgery, he experienced repeated abdominal pain and diarrhea induced by oral intake, and detailed examination including computed tomography (CT) and protein loss scintigraphy led to a diagnosis of protein-losing gastroenteropathy complicating ischemic enteritis. In a third surgery, a laparoscope was used for detailed observation, and thickening of the small intestine wall was observed across about 50 cm on the oral side of the previous anastomosis. We report and discuss this case where, despite an attempted “second-look operation” to avoid massive small intestine resection, a third surgery and long-term hospitalization were needed as a consequence of complications from protein-losing gastroenteropathy.
