Successful management of extensive bowel resection without intestinal continuity: a case report

Patients with intestinal ischemia associated with acute aortic dissection often require emergent bowel resection, which results in serious complications. We present a case of successful surgical management of extensive bowel necrosis caused by acute aortic dissection. A 42-year-old man underwent emergent subtotal resection of the small intestine, right colectomy, tube gastrostomy, and transverse colostomy; however, intestinal continuity was not restored. He developed two major postoperative complications: unconsciousness due to metabolic alkalosis caused by massive discharge from the gastrostomy and jaundice due to bile salt depletion caused by disruption of the enterohepatic circulation. His serum bilirubin levels decreased after the infusion of gastric discharge through gastrostomy into the transverse colon through the colostomy; thereafter, a second operation was performed to restore gastrointestinal continuity. Overall, patients undergoing massive bowel resection without intestinal continuity require careful management of electrolytes and bile salt.