Mesenteric revascularization in a contaminated abdomen: a case report.
R M Young1, J J Hoballah, W J Sharp
1Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Vascular Surgery
|September 21, 2001
Summary
This case study demonstrates successful mesenteric revascularization using a saphenous vein graft in a patient with acute mesenteric ischemia and abdominal sepsis. A subsequent aneurysm in the graft was successfully managed with a polytetrafluoroethylene interposition graft.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Abdominal Surgery
Background:
- Acute mesenteric ischemia (AMI) with abdominal sepsis presents a complex surgical challenge.
- Autogenous grafts are often necessary for mesenteric revascularization in contaminated abdominal cases.
Observation:
- A 62-year-old woman presented with AMI and small bowel perforation, involving occlusion of major mesenteric arteries.
- Preoperative evaluation revealed a suitable dual right greater saphenous vein system for grafting.
- Exploratory laparotomy confirmed diffuse bowel and liver ischemia, and abdominal sepsis.
Findings:
- Mesenteric revascularization was achieved using a nonreversed bifurcated saphenous vein graft from the supraceliac aorta to the hepatic and superior mesenteric arteries.
- Immediate reperfusion of the bowel and liver was observed post-revascularization.
- A 6 cm aneurysm developed in the saphenous vein graft 5 months postoperatively, necessitating replacement with a polytetrafluoroethylene (PTFE) interposition graft.
- The PTFE graft remained patent without recurrence at 3-month follow-up, with the patient remaining asymptomatic.
Implications:
- Saphenous vein grafts can be a viable option for mesenteric revascularization in complex AMI cases.
- Monitoring for and managing potential complications like aneurysms in autogenous mesenteric bypass grafts is crucial.
- PTFE grafts offer a durable alternative for managing complications in mesenteric bypass surgery.
