Behind The Knife: The Surgery Podcast

Behind the Knife en español: repaso para la certificación en cirugía general- Isquemia mesentérica - (Mesenteric Ischemia)

Nov 28, 2025
Dive into a riveting case of mesenteric ischemia involving a 65-year-old woman with acute abdominal pain. Explore the critical initial tests like ECG and CT angiography essential for diagnosis. Learn about the immediate management protocols, including IV heparin and antibiotics, before surgery. Discover the operative techniques for SMA embolectomy and strategies for assessing bowel viability. Gain insights on differentiating thrombotic from embolic ischemia, alongside exam tips for mastering complicated scenarios in surgical practice.
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ADVICE

Complete Rapid Evaluation Before Surgery

  • Perform a focused but complete evaluation including CBC, BMP, lactate, amylase, lipase, ECG and CT angiography with IV contrast.
  • See the patient immediately and gather labs and imaging before deciding on operative intervention.
ADVICE

Immediate Anticoagulation And Antibiotics

  • Start systemic IV heparin immediately for confirmed arterial embolic mesenteric ischemia (initial bolus ~80 units/kg).
  • Continue broad-spectrum antibiotics and coordinate vascular assistance for embolectomy.
ADVICE

Surgical Steps For Embolic SMA Occlusion

  • Perform exploratory laparotomy, expose the SMA via mobilizing the transverse colon and follow the middle colic to the mesenteric root.
  • Control the vessel, give IV heparin, perform transverse arteriotomy and Fogarty embolectomy, then close and confirm flow with Doppler.
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