SURGICAL TREATMENT OF ACUTE SUPERIOR MESENTERIC ARTERY OCCLUSION AFTER ENDOVASCULAR THERAPY

Although acute superior mesenteric artery (SMA) occlusion comprises two-thirds of the pathology in patients with acute mesenteric ischemia, non-occlusive mesentery ischemia and mesenteric venous thrombosis are rarely encountered. We herein aim to present the outcomes of endovascular surgery in a patient with SMA occlusion who developed peritonitis following endovascular embolectomy and stenting. Old female patient admitted to emergency service with a complaint of abdominal pain for the past 4 days. Contrast abdominal CT in the emergency service revealed the existence of a thrombus that almost occludes the lumen with a size of 2,5-3 cm at proximal SMA and that distal SMA and distal branches were unobstructed with no evidence of abdominal free fluid and typical ischemia in bowel loops. Thrombectomy was performed to remove the acute thrombus which was proximal to SMA. The patient was treated by end-to-end anastomosis of the 50 cm-long unaffected bowel segment with small intestine at distal end and with transverse colon at proximal end, following necrotic bowel resection. The patient was released from hospital 10 days after the surgery without complication. It has been suggested that CT must be used as the primary imaging method since it has high sensitivity (93.3%) and specificity (95.9%) for suspected acute SMA occlusion. Surgical intervention must be planned upon clinical or radiological suspicion before the development of a septic condition. We conclude that endovascular intervention must be considered primarily for protection of intestinal segments unless complications of SMA thrombus have developed.