A case of acute exacerbation of chronic mesenteric ischemia saved by Hybrid therapy with endovascular and surgical treatment

DOI
  • Horikawa Daisuke
    Division of Gastrointestinal Surgery, Department of Surgery, Asahikawa Medical University
  • Hagiwara Masahiro
    Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University
  • Takahashi Hiroyuki
    Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University
  • Imai Koji
    Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University
  • Otani Masahide
    Division of Gastrointestinal Surgery, Department of Surgery, Asahikawa Medical University
  • Tani Chikayoshi
    Division of Gastrointestinal Surgery, Department of Surgery, Asahikawa Medical University
  • Hasegawa Kimiharu
    Division of Gastrointestinal Surgery, Department of Surgery, Asahikawa Medical University
  • Matsuno Naoto
    Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University
  • Yokoo Hideki
    Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University

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Other Title
  • 慢性腸間膜虚血の急性増悪に対して，外科的治療と血管内治療を併用したHybrid治療で救命した1例

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A 66-year-old woman presented to another hospital with abdominal pain. CT showed CA occlusion, SMA stenosis, and collateral via IMA. After referral to our hospital on suspicion of intestinal necrosis, CT showed increased ascites and ileal wall thickening. Exploratory laparotomy was conducted, however, no evident intestinal necrosis was identified. On postoperative day 5, the patient developed diffuse abdominal pain, CT showed ischemia in the ileum; thus, exploratory laparotomy was performed a second time. Because of ischemic changes in the ileum, and no palpable marginal artery of the right colon, right hemicolectomy without reconstruction was performed, followed by open-abdominal-management. During second-look laparotomy, an endovascular stent was inserted into the IMA to treat IMA stenosis identified by angiography. The intestine was reconstructed, and an ileostomy was placed. Hybrid therapy was thought to be useful in the treatment of an acute exacerbation of chronic mesenteric ischemia.

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