Experience in curing refractory gastrointestinal bleeding due to type A aortic dissection combined with mesenteric artery malperfusion: a case report

Aortic dissection (AD) is a cardiovascular emergency that seriously endangers human health. It has acute onset, dangerous condition and many complications. The mortality without treatment is very high, and the mortality within 24 hours is 25%. AD combined with mesenteric artery malperfusion has an incidence of only 5%, but a hospital mortality rate of up to 33-100%. Mesenteric artery malperfusion increases the mortality of acute AD by 3-4 times. Even after complete revascularization, ischemia/reperfusion injury still leads to frequent postoperative deaths. In this paper, we describe the case of a 60-year-old man with type A aortic dissection and mesenteric artery malperfusion who developed refractory gastrointestinal bleeding postoperatively. He was cured after conservative, interventional, and surgical hemostasis, finally recovered and discharged. This case provides a certain reference value for clinical treatment of such diseases. Aortic dissection combined with mesenteric artery malperfusion is a significant surgical challenge. Ischemia/ reperfusion injury may still occur after thoracotomy, even when the blood supply is normalized. Immediate surgery is recommended for preventing death from acute AD, but the strategy should be modified according to the specific symptoms and ischemic severity. In addition, interventional/surgical treatment should be performed more actively in patients with refractory gastrointestinal bleeding after cardiac surgery and a poor response to conservative treatment.