Arab Board Surgery Final Written

Practice session

A 69-year-old woman with a history of atrial fibrillation on irregular anticoagulation presents with sudden-onset, agonizing diffuse abdominal pain. On examination, the abdomen is soft and non-distended with minimal tenderness, showing classic 'pain out of proportion to physical findings.' CT angiography demonstrates an abrupt cutoff in the mid-portion of the superior mesenteric artery (SMA) distal to the middle colic takeoff. What is the immediate operative management?

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