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World J Gastroenterol. Aug 7, 2014; 20(29): 9936-9941
Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.9936
Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion
Stefan Acosta
Stefan Acosta, Vascular Centre, Malmö, Skåne University Hospital, S205 02 Malmö, Sweden
Author contributions: Acosta S solely contributed to this manuscript.
Correspondence to: Stefan Acosta, MD, PhD, Vascular Centre, Malmö, Skåne University Hospital, Ruth Lundskogsgata 5, S205 02 Malmö, Sweden.
Telephone: +46-40-331000 Fax: +46-40-338097
Received: November 13, 2013
Revised: December 28, 2013
Accepted: January 19, 2014
Published online: August 7, 2014
Core Tip

Core tip: Timely diagnosis of acute occlusion of the superior mesenteric artery (SMA) is possible with computed tomography angiography. The establishment of a hybrid operating room is most important to be able to perform explorative laparotomy for evaluation of the extent of mesenteric ischemia and successful intestinal revascularization. In embolic SMA occlusion, open embolectomy is performed followed by angiography. In thrombotic SMA occlusion, the occlusive lesion can be recanalized retrograde from an exposed SMA, the guidewire snared from either the femoral or brachial artery, and stented with standard devices. A necrotic bowel is resected with reconstructions performed at a planned second look laparotomy.