Presentation
Acute upper abdominal pain.
Patient Data
CT image demonstrates embolic disease within the mid-superior mesenteric artery, renal infarction and small-bowel and ileocecal ischemia with poor wall enhancement.
Hyperattenuating sign is seen in SMA.
This is due to increased concentration of hemoglobin as water content decreases.
Abdominal angiography performed 5 hours from onset revealed complete obstruction in the distal portion of the SMA above middle colic artery that supplies the majority of the transverse colon.
We performed urokinase infusion and thrombus suction via the angiography catheter. However, the thrombus persisted, and intramural blood flow was poor, necessitating exploratory laparotomy.
A long length of small intestine and the cecum were surgically removed.
Filling defect is in the SMA.
Blood clot typically has high attenuation.
Multiple perfusion defects in both kidneys.
Case Discussion
The superior mesenteric artery (SMA) provides vital blood supply to the intestine, and an acute obstruction causes bowel ischemia and infarction which is frequently fatal.
A delay in diagnosis results in an extremely high mortality rate due to extensive intestinal necrosis. Successful resection of necrotic intestine can cause short bowel syndrome, severely impairing quality of life.
Enhanced CT is useful for early diagnosis of acute SMA occlusion. When acute SMA occlusion is suspected from the history, lab results and examination, enhanced CT plays a role not only in identifying the site and cause of the blockage, but also in determining the subsequent treatment plan.
Primary endovascular therapy for acute embolic SMA occlusion was unsuccessful, necessitating emergency laparotomy.
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