RESUMO
A 77-year-old male patient presented with a 5-day history of abdominal pain, coffee ground vomiting and blood-stained diarrhoea. CT scan of the abdomen and pelvis demonstrated a long segment thrombotic occlusion of the superior mesenteric vein (SMV) extending up to the proximal portion of the portal vein causing significant acute small bowel ischaemia. Patient's deteriorating clinical condition warranted surgical management. Successful surgical management required multidisciplinary teamwork between emergency, vascular surgeons, anaesthetists and intensivists. Emergency laparotomy revealed gangrene of an estimated 120 cm of small bowel segment starting from duodenojejunal junction and a long segment thrombotic occlusion of the SMV extending up to the portal confluence. Resection of gangrenous small bowel without anastomosis and thrombo-embolectomy of SMV along with laparostomy was done at the initial operation. Patient was admitted in the intensive care unit on systemic heparinisation through intravenous administration of unfractionated heparin. Second relook exploration was done after 48 hours followed by anastomosis of the small bowel and closure of the abdomen. Patient made a good recovery following anticoagulation therapy and was discharged on postoperative day 10.
Assuntos
Isquemia Mesentérica , Oclusão Vascular Mesentérica , Trombose , Idoso , Heparina/uso terapêutico , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/cirurgia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/etiologia , Oclusão Vascular Mesentérica/cirurgia , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/cirurgia , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Trombose/complicações , Trombose/diagnóstico por imagemAssuntos
Trombose Venosa Profunda de Membros Superiores , Produtos de Degradação da Fibrina e do Fibrinogênio , Humanos , Veia Subclávia , Terapia Trombolítica , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem , Trombose Venosa Profunda de Membros Superiores/tratamento farmacológicoRESUMO
A 70-year-old man was investigated with CT imaging for haematuria. An incidental finding was made of a large inferior pancreaticoduodenal artery aneurysm. Following a period of monitoring, the patient underwent open repair of the aneurysm. This case report highlights an unusual pathology and discusses the clinical complexities related to its management.