A patient with acute mesenteric ischemia who was managed with bowel resection and superior mesenteric artery bypass.

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A 73-year-old man patient was admitted to the hospital because of cerebral infarction. Atrial fibrillation was seen in his stable ECG. On the 6th hospital day, he had sudden onset of severe abdominal pain but no other critical physical signs were presented. In a half day after the onset of the symtom, the pain was intensified and his peritoneal sign gradually revealed. In laboratory data, white blood cell counts remarkably increased and elevations of GOT and LDH were confirmed. On an angiogram, the superior mesenteric artery (SMA) was invisible due to thrombosis, and he immediately underwent an operation. Ischemic bowel necrosis existed in almost entire the small intestine except the duodenum and a proximal jejunum, and left half of the colon. Combined bowel resection and enterostomies (jejunostomy and colostomy) were selected for the treatment. Abdominal aorta-SMA bypass with an autologous saphenous vein was performed in order to increase blood supply to the residual bowel and to preserve the organ function ideally. In the second operation, a jejuno-colonostomy was completed without postoperative complications. The patient requires total parenteral nutrition but he can have some nutrients by mouth. Ten months have passed since the first operation and he can almost do his daily work independently.
日本臨床外科学会の論文