Abstract
A 63-year-old man was admitted with severe back pain of sudden onset. An enhanced computed tomography (ECT) revealed a Stanford type B (DeBakey IIIa) acute aortic dissection. Blood pressure was controlled satisfactorily with nicardipine hydrochloride infusion. Five days after admission, he suffered sever back pain again followed by abdominal and left leg pain, and pulselessness of the left leg and abdominal extension, which suggested an intestinal malperfusion. The ECT showed re-dissection reaching the iliac artery level. Emergency laparotomy showed small intestinal ischemia. Surgical fenestration beneath the inferior mesenteric artery, and reconstruction with a bifurcated graft were performed satisfactorily. The color of the small intestine returned to normal, and peripheral pulse in the left leg was easily palpable. The patient has been receiving care as an outpatient.
