Mesenteric revascularization in a contaminated abdomen: a case report.
The management of acute mesenteric ischemia in the contaminated abdomen may require the use of an autogenous graft to achieve mesenteric revascularization. The authors present a case of an ischemic small bowel perforation in a 62-year-old-woman whose preoperative angiogram demonstrated occlusion of the celiac, superior mesenteric, and inferior mesenteric arteries. Vein mapping of the right greater saphenous vein demonstrated a dual saphenous system whose individual diameters were more than 4 millimeters. Exploratory laparotomy revealed a diffusely ischemic small bowel and liver, as well as abdominal sepsis from the perforated small bowel. Revascularization was accomplished by using saphenous vein in a nonreversed orientation as a bifurcated conduit from the supraceliac aorta to the hepatic and superior mesenteric arteries. Following revascularization, the liver and small bowel immediately regained a normal perfused appearance and the perforated segment of small bowel was resected and reanastomosed. She returned for a follow-up clinic visit 5 months later and was found to have an asymptomatic 6 cm aneurysm involving the proximal mesenteric vein bypass. The aneurysmal aspect of the vein bypass was replaced with a polytetrafluoroethylene interposition graft originating from the supraceliac aorta. On follow-up 3 months later, her aortomesenteric bypass is patent without aneurysmal recurrence, and she is clinically asymptomatic from any symptoms of mesenteric ischemia.
Young
R M
RM
Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Hoballah
J J
JJ
Sharp
W J
WJ
Corson
J D
JD
D000005:Abdomen / Q000382:microbiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000293:injuries / Q000601:surgery; D017537:Mesenteric Artery, Inferior / Q000601:surgery*; D017538:Mesenteric Artery, Superior / Q000601:surgery*; D008875:Middle Aged; D012421:Rupture / Q000601:surgery; D014656:Vascular Surgical Procedures