Avoidance of open surgery for superior mesenteric artery occlusion by a combination of diagnostic laparoscopy and intraoperative endovascular treatment

The patient was a 55-year-old man who was brought to the hospital as an emergency with a chief complaint of abdominal pain. The patient had a past history of atrial fibrillation. Abdominal contrast CT revealed occlusion of the ileocolic artery and both reduced blood flow and edematous changes in the ileum, and a diagnosis of superior mesenteric artery (SMA) occlusion was made. Intestinal necrosis was suspected based on the physical and diagnostic imaging findings, and urgent diagnostic laparoscopy was performed. Examination of the abdominal cavity revealed a slightly discolored segment of intestine extending for approximately 1 meter from the end of the ileum, but because there was good peristalsis, progression to necrosis was ruled out. We then performed intraoperative endovascular treatment and observed the improvement in blood flow. Repeat laparoscopy confirmed the absence of intestinal discoloration, and we concluded the operation. The postoperative course was favorable, and the patient was discharged on postoperative day 14. Cases of SMA occlusion in which it has been possible to avoid open surgery by performing diagnostic laparoscopy and intraoperative endovascular treatment are rare. Performing diagnostic laparoscopy in an operating room where endovascular treatment can be performed in SMA occlusion cases in which the viability of the intestine is unknown makes it possible to immediately choose the method of treatment and perform it, and if no intestinal necrosis is observed, open surgery can be avoided.