Presentation
Severe acute abdominal pain since one day.
Patient Data
Triphasic CT abdomen shows a filling defect in the mid portion of superior mesenteric artery (beginning ~5.3 cm distal to origin) and it's jejunal/ileal branches causing complete occlusion.
Intramural air in the jejunal and proximal ileal loops with mild dilatation of proximal jejunal loops (4.0 cm in diameter) - representing mesenteric ischemia. There is air in the corresponding mesenteric venules. No portal venous air.
There is edematous wall thickening of mid and distal ileal loops (4 mm in thickness) with reduced wall enhancement - representing early ischemic changes.
Mild free fluid.
These features are consistent with acute mesenteric ischemia due to superior mesenteric artery thrombosis.
Case Discussion
Acute mesenteric ischemia can be due to thrombus, embolus, mesenteric venous thrombosis or non-occlusive mesenteric ischemia.
Bowel dilatation, reduced bowel wall enhancement, intramural air and portal venous air are various signs of acute mesenteric ischemia.
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