Supraceliac Aorta-to-SMA Bypass with Ileocecectomy for Acute-on-Chronic Mesenteric Ischemia Complicated by Bowel Necrosis and Perforation

1. Introduction

2. Access to the Abdomen

3. Encountered Bowel Perforation and Massive Ischemia - Determine Extent and Adjust Approach

1. Bowel Resection Around Perforation
2. Extend Bowel Resection
3. Consult
4. Ileocecectomy

4. Distal/SMA Exposure and Dissection

5. Mobilization of the Left Lobe of the Liver

6. Supraceliac Exposure

1. Take Down Median Arcuate Ligament

7. Control Adventitial Tears with Pledgeted Sutures

8. Retropancreatic Tunnel

9. Prepare Conduit

10. Place Side-Biting Clamp on Aorta

11. Arteriotomy

12. Aortic Punch to Remove Ellipse of Aorta

13. Proximal Anastomosis of Conduit to Aorta

14. Pass Conduit Through Retropancreatic Tunnel

15. Distal Anastomosis of Conduit

16. Reperfusion

17. Test Anastomoses

18. Final Inspection and Hemostasis

19. Closure

20. Post-op Remarks