Hybrid surgery in a young patient with mesenteric thrombosis induced by psychoactive substances (clinical observation)

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The article presents a clinical case of patient S. 36 years old with a diagnosis of acute occlusive PAS-induced (psychostimulants) mesenteric ischemia, thrombosis of the superior mesenteric artery, subtotal necrosis of the small intestine, widespread diffuse serous fibrinous peritonitis.

Patient S. underwent hybrid surgery – angiography of the celiac trunk, endovascular thromboextraction from the superior mesenteric artery, diagnostic laparoscopy, laparotomy, small intestine resection, sanitation, drainage of the abdominal cavity. After 34 hours, the patient underwent programmed relaparotomy ("second look"), revision of the abdominal organs, resection of a section of the small intestine with necrotic changes, the formation of an enteroenteroanastomosis "side-to-side", sanitation, drainage of the abdominal cavity. In the early postoperative period, the patient developed the following complications: intoxication syndrome, sepsis, water-electrolyte disorders, hypoalbuminemia, anemia of moderate severity, suppuration of a laparotomy wound. During therapy all postoperative disorders regressed. The length of hospital stay was 18 days.

The use of hybrid surgical access allowed to operate with a reduction in the volume of the resected intestine, giveв the possibility of creating an anastomosis and discharge the patient.

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作者简介

M. Rogal

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

编辑信件的主要联系方式.
Email: vasacorona@yandex.ru
ORCID iD: 0000-0003-1327-6973
SPIN 代码: 4591-3844

Candidate of Medical Sciences

俄罗斯联邦, Moscow

P. Yartsev

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0000-0003-1270-5414
SPIN 代码: 4044-9661

Professor, MD

俄罗斯联邦, Moscow

N. Stinskaya

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0000-0001-8319-7440
SPIN 代码: 6087-8380
俄罗斯联邦, Moscow

A. Spassky

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0000-0003-1823-0982
SPIN 代码: 7898-1643
俄罗斯联邦, Moscow

R. Elokhovsky

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0009-0005-5974-9846
俄罗斯联邦, Moscow

Y. Sadzaya

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0009-0002-6774-9967
俄罗斯联邦, Moscow

N. Shavrina

N.V. Sklifosovky Research Institute for Emergency Medicine of the Moscow Health Department

Email: vasacorona@yandex.ru
ORCID iD: 0000-0002-3766-4674
SPIN 代码: 2800-3548

Candidate of Medical Sciences

俄罗斯联邦, Moscow

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2. Fig. 1. 3D-CT reconstruction of abdomen with intravenous contrast: thrombosis of the superior mesenteric artery

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3. Fig. 2. Angiography of the celiac trunk: filling defect (indicated by arrow), an extended thrombus in the superior mesenteric artery

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4. Fig. 3. Necrotic loops of the small intestine

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5. Fig. 4. Proximal (a) and distal (б) edges of small intestine resection

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