Acute superior mesenteric artery occlusion

Case contributed by RMH Report Writing

Presentation

Severe abdominal pain. Bowel obstruction?

Patient Data

Age: 91 years
Gender: Female
CT

CT Abdomen and pelvis

 

No distended loops of bowel to suggest obstruction, however, the small bowel loops are mildly thick-walled. There is colonic diverticulosis but no evidence of acute florid diverticulitis. The appendix is not visualised. No free or loculated intra-abdominal fluid collection and no free intraperitoneal gas. There is atherosclerosis in the abdominal aorta, splanchnic and iliac arteries. There is absent opacification of the superior mesenteric artery from approximately 3.5 cm distal to its origin consistent with superior mesenteric artery occlusion/thrombosis. No intramural, mesenteric or portal venous gas to suggest bowel infarction.

The liver has a heterogeneous enhancement pattern which may be in part due to the phase of the study. The superior mesenteric and portal veins are quite small in size and there is opacification of the hepatic arteries. The gallbladder is absent and surgical clips in the gallbladder fossa consistent with the previous cholecystectomy. The pancreas is atrophic. The spleen, adrenal glands and kidneys are normal. No urolithiasis or hydronephrosis. A dislodged surgical clip is noted inferior to the right lobe of the liver posteriorly. No para-aortic lymphadenopathy.

There is severe degenerative spondylosis throughout the lumbar spine with a grade 1 spondylolisthesis in the lower lumbar spine region. No destructive skeletal lesions. There is quite extensive atelectasis and groundglass density in the lower lobes associated with interlobular septal thickening and cardiomegaly is noted. The appearance suggests acute left ventricular failure.

 

Case Discussion

Absent opacification of the superior mesenteric artery consistent with acute occlusion/thrombosis. No distended loops of bowel although there is mild small bowel wall thickening but no intramural, mesenteric or portal venous gas to suggest bowel infarction.

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Case information

rID: 43926
Case created: 29th Mar 2016
Last edited: 15th Sep 2017
Tag: rmh
Inclusion in quiz mode: Included

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