Double-staged thromboembolectomy in acute visceral ischemia with atypical origin of right hepatic artery, complicated by secondary intestinal infiltrate.

INTRODUCTION: Acute mesenteric ischemia is a rare but serious vascular complication often accompanied by intestinal damage. Treatment typically involves surgical and endovascular procedures. Proper diagnostic and interventional techniques are critical for preventing complications, resulting in short bowel syndrome, sepsis or need for repeated surgeries. Based on the case report, our publication provides an overview of managing acute mesenteric ischemia with intestinal involvement, highlighting both conventional and modern treatment approaches.

CASE REPORT: A 57-year-old woman with thyrotoxicosis suffered from acute visceral ischemia, caused by subtotal obstruction of the superior mesenteric artery along with small bowel infarction. After surgical arterial recanalization and intestinal resection, despite palpable pulsations in the hepatic region, a new occlusion of the accessory right hepatic artery was diagnosed.Following the second revision, blood flow was restored. During follow-up, abdominal complaints recurred, requiring ileocecal resection due to delayed ischemic changes.

CONCLUSION: Causes of visceral ischemia are multiple. Effective diagnosis and treatment require an interdisciplinary approach. This includes open, endovascular, or hybrid techniques combined with intestinal resection.