Jejunal transection caused by postoperative adhesive small bowel obstruction: managed simultaneously with abdominal aortic aneurysm.

Abstract

A man in his 90s presented with abdominal pain and was referred to our hospital. Contrast-enhanced CT revealed an abdominal aortic aneurysm (AAA) without evidence of rupture and marked dilatation of the small bowel, leading to a diagnosis of postoperative adhesive small bowel obstruction. Conservative management with a long intestinal tube failed to relieve bowel obstruction, but the patient initially declined surgery and was transferred back to the referring hospital. After his symptoms persisted, he agreed to operative treatment and was readmitted. Following a preoperative multidisciplinary team conference, a simultaneous approach was selected to address both the bowel obstruction and the AAA. Endovascular aneurysm repair was performed first, followed by laparotomy. Intraoperatively, the jejunum was found to be completely transected, forming two blind ends secondary to severe adhesions. Partial resection of the affected bowel and primary anastomosis were performed. He was transferred to a rehabilitation facility on postoperative day 24.