Urgent Reno-Hepatic Artery Bypass for Acute on Chronic Mesenteric Ischemia Following Robotic Low Anterior Resection for Rectal Cancer in a Patient with Severe Stenosis of the Hepatosplenomesenteric Trunk
Year: 2026
Type: article
Study design: Case Report
Abstract: INTRODUCTION: Acute mesenteric ischemia, including acute exacerbation of chronic mesenteric ischemia (CMI), is a life-threatening condition associated with a 50% in-hospital mortality risk and requires immediate diagnosis, revascularization, and resection of necrotic organs. In colorectal surgery, mesenteric artery stenosis can lead to anastomotic leakage which increases morbidity and mortality. Here, we describe a case of acute exacerbation of CMI caused by severe stenosis of the hepatosplenomesenteric trunk (HSMT) and ligation of the left colic and inferior mesenteric arteries in an earlier rectal surgery that was successfully treated with urgent reno-hepatic artery bypass. CASE PRESENTATION: An 80-year-old woman was referred to our department with acute exacerbation of CMI after multiple procedures for rectal cancer. Contrast-enhanced CT revealed severe stenosis with calcification at the origin of the HSMT and hypoenhancement of the right hepatic lobe, spleen, and small intestine. Percutaneous antegrade endovascular stenting failed because the lesion was severely calcified. We opted to perform urgent open surgery, including revascularization and resection of the necrotic organs. A bypass from the right renal artery to the proper hepatic artery was selected because of the high risk of failure associated with retrograde open mesenteric stenting, the limited length of available saphenous vein, the risk of anastomotic failure secondary to infection, the patient's poor general condition, and the degree of calcification precluding aortoiliac clamping. Postoperatively, the patient developed Takotsubo cardiomyopathy and disseminated intravascular coagulation, both of which were successfully managed and resolved in the ICU. On POD 24, the patient underwent duodeno-jejunal anastomosis, ileostomy closure, and colostomy. The patient tolerated oral intake well 80 days after arterial bypass surgery and was discharged on POD 147 on single antiplatelet therapy. CONCLUSIONS: Although hepato-renal artery bypass is typically used for renal revascularization, reno-hepatic bypass can be useful for mesenteric revascularization in patients with anatomical variations, peritonitis, or severe aortoiliac calcification.
Source: Surgical Case Reports
Institution: Saiseikai Kawaguchi General Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,535
OpenAlex ID: W7225317689