title: Acute aortic dissection with intestinal ischemia: what to do first.
abstract: OBJECTIVE
  In the case of an acute aortic dissection, a surgical aortic procedure is usually the priority in order to restore the perfusion of vital organs. Afterwards, associated ischemic abdominal visceral lesions can be resected. For particular patients, it could be highly beneficial to perform the abdominal surgery before surgically addressing the aorta. The aim of this paper is to contribute to the therapeutic choice in cases of acute aortic dissection with acute abdomen.
  
  
  METHODS
  The case is reported of a 38-year-old patient, affected by an acute aortic dissection (Stanford type A) and peritonitis.Suspecting the necessity for a complex combined surgical procedure, the patient underwent emergency diagnostic laparoscopy, which showed an infarctual necrosis of the distal ileum and right colon. Therefore, he immediately underwent a wide right hemicolectomy. Afterwards, an ascending aortic substitution was performed.The patient was discharged on the 15th post-operative day, and he is doing well, 1 year and 3 months after the operation.
  
  
  CONCLUSIONS
  In the case of an acute aortic dissection with acute abdomen, emergency laparoscopy is a precious surgical technique to identify criteria that can lead to therapeutic decisions, including timing.
authors: Department of Surgical Sciences, University of Pavia, IRCCS San Matteo Hospital Foundation, Viale Liberta 35, Pavia, Italy. f.meriggi@smatteo.pv.it
authors: Francesco
authors: F
authors: Meriggi
authors: Alessia
authors: A
authors: Alloni
authors: Paolo
authors: P
authors: Gramigna
authors: Paola
authors: P
authors: Tramelli
authors: Mario
authors: M
authors: Vigano
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology; D000208:Acute Disease; D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D003082:Colectomy; D006801:Humans; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009336:Necrosis; D010538:Peritonitis / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome