A 70 years old diabetic hypertensive patient COVID 19 positive presented to ER with abdominal pain for 2 days. CT showed thrombus at the origin of SMA. Patient taken to OR SMA exploration with thrombectomy done. 200cm where ischemic at mid jejunun till distal ileum. Left around 180cm from proximal jejunum and 40 cm from ileum distally. Temporarily abdominal closure by VAC dressing for secound look. At night pateint develop acute MI and started on ACS protocol. In second look after 48 h found 140 cm of jejunum are ischemic the ileum remenst is healthy.
What you well do?
Was thrombectomy only the proper decision?
- The SMA is atherosclerotic and recurrence of thrombosis is expected.
- I am not a vascular surgeon, but I like to inquire: why a bypass was not done during the 1st surgery to revascularize the remaining viable part of the midgut?.
- Was the pathology embolism, so embolectomy only was done?