LAUSR

A 48-year-old male diagnosed with classical chronic mesenteric ischaemia along with features of hepatic ischaemia as revealed by low prothrombin time index and contrast computerised tomography (CT) showing small tiny ischaemic fibrotic nodules in liver parenchyma. Computerised tomography angiogram of the abdomen showed occluded celiac artery, superior mesenteric artery and inferior mesenteric artery. Patient required early treatment and the need was to restore blood flow to common hepatic artery and superior mesenteric artery. Open surgical revascularisation was planned considering his young age, longer patency of open bypasses with lesser reintervention rate in follow-up. Patient was optimised by infusion of fresh frozen plasma and injection vitamin K before being taken for surgery. Antegrade supraceliac aorta to common hepatic and superior mesenteric artery bypass was done successfully. Patient developed ascites and elevation of transaminases postoperatively which settled gradually over a week after management with diuretics and albumin infusion. Patient is doing fine at follow-up of more than 16 months.