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A Staged Operation as a Surgical Strategy for a Patient with Type VI Isolated Superior Mesenteric Artery Dissection
An isolated superior mesenteric artery (SMA) dissection (ISMAD) is extremely rare among visceral artery dissections. Its diagnosis is made by abdominal contrast CT scan which shows SMA occlusion partially or completely. The ISMAD is classified into 6 types: type I–V has partial occlusion and treated...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
S. Karger AG
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436718/ https://www.ncbi.nlm.nih.gov/pubmed/34594171 http://dx.doi.org/10.1159/000518018 |
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author | Nishi, Ryosuke Fujita, Yasuhiko Amagai, Teruyoshi |
author_facet | Nishi, Ryosuke Fujita, Yasuhiko Amagai, Teruyoshi |
author_sort | Nishi, Ryosuke |
collection | PubMed |
description | An isolated superior mesenteric artery (SMA) dissection (ISMAD) is extremely rare among visceral artery dissections. Its diagnosis is made by abdominal contrast CT scan which shows SMA occlusion partially or completely. The ISMAD is classified into 6 types: type I–V has partial occlusion and treated medically using antiplatelets or anticoagulants. On the other hand, type VI has complete occlusion and must be treated by urgent surgical operation. We present a 67-year-old female who presented with sudden onset abdominal pain and melena. An urgent contrast CT revealed type VI ISMAD. She underwent 3 staged operations as follows: (1) first, as laparotomy showed pale color in almost the extensive length of the small intestine, arterial bypassing of SMA was undertaken using SMA to the right common iliac artery bypass; (2) as the second-look operation on the next day, the terminal ileum was resected, and the remaining small intestine was able to be preserved. However, when the abdomen was tried to be closed, systemic blood pressure decreased to pre-shock condition, so the abdominal wall was closed at skin level with silastic sheet. (3) As the third-look operation on the 7th day, ileostomy was created, and the abdominal wall was safely closed. The postoperative course was uneventful. This case study shows that SMA grafting and staged operations might be an option to preserve the length of the small intestine when ISMAD is diagnosed as type VI. |
format | Online Article Text |
id | pubmed-8436718 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | S. Karger AG |
record_format | MEDLINE/PubMed |
spelling | pubmed-84367182021-09-29 A Staged Operation as a Surgical Strategy for a Patient with Type VI Isolated Superior Mesenteric Artery Dissection Nishi, Ryosuke Fujita, Yasuhiko Amagai, Teruyoshi Case Rep Gastroenterol Single Case An isolated superior mesenteric artery (SMA) dissection (ISMAD) is extremely rare among visceral artery dissections. Its diagnosis is made by abdominal contrast CT scan which shows SMA occlusion partially or completely. The ISMAD is classified into 6 types: type I–V has partial occlusion and treated medically using antiplatelets or anticoagulants. On the other hand, type VI has complete occlusion and must be treated by urgent surgical operation. We present a 67-year-old female who presented with sudden onset abdominal pain and melena. An urgent contrast CT revealed type VI ISMAD. She underwent 3 staged operations as follows: (1) first, as laparotomy showed pale color in almost the extensive length of the small intestine, arterial bypassing of SMA was undertaken using SMA to the right common iliac artery bypass; (2) as the second-look operation on the next day, the terminal ileum was resected, and the remaining small intestine was able to be preserved. However, when the abdomen was tried to be closed, systemic blood pressure decreased to pre-shock condition, so the abdominal wall was closed at skin level with silastic sheet. (3) As the third-look operation on the 7th day, ileostomy was created, and the abdominal wall was safely closed. The postoperative course was uneventful. This case study shows that SMA grafting and staged operations might be an option to preserve the length of the small intestine when ISMAD is diagnosed as type VI. S. Karger AG 2021-08-02 /pmc/articles/PMC8436718/ /pubmed/34594171 http://dx.doi.org/10.1159/000518018 Text en Copyright © 2021 by S. Karger AG, Basel https://creativecommons.org/licenses/by-nc/4.0/This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission. |
spellingShingle | Single Case Nishi, Ryosuke Fujita, Yasuhiko Amagai, Teruyoshi A Staged Operation as a Surgical Strategy for a Patient with Type VI Isolated Superior Mesenteric Artery Dissection |
title | A Staged Operation as a Surgical Strategy for a Patient with Type VI Isolated Superior Mesenteric Artery Dissection |
title_full | A Staged Operation as a Surgical Strategy for a Patient with Type VI Isolated Superior Mesenteric Artery Dissection |
title_fullStr | A Staged Operation as a Surgical Strategy for a Patient with Type VI Isolated Superior Mesenteric Artery Dissection |
title_full_unstemmed | A Staged Operation as a Surgical Strategy for a Patient with Type VI Isolated Superior Mesenteric Artery Dissection |
title_short | A Staged Operation as a Surgical Strategy for a Patient with Type VI Isolated Superior Mesenteric Artery Dissection |
title_sort | staged operation as a surgical strategy for a patient with type vi isolated superior mesenteric artery dissection |
topic | Single Case |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436718/ https://www.ncbi.nlm.nih.gov/pubmed/34594171 http://dx.doi.org/10.1159/000518018 |
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