SMA thrombus causing small bowel ischaemia

Case contributed by Dr Andrew Walker

Presentation

58 year old patient attended A+E with acute lower abdominal pain. Blood tests showed raised inflammatory markers only initially. CT requested "?cause for pelvic pain"

No cause for pelvic pain was demonstrated.

However, renal infarcts are demonstrated as well as intra-ventricular thrombus. The possibility of ischaemic bowel was raised in the report.

Ongoing lower abdominal pain lead to further clinical review. Ischaemic bowel was raised as a differential diagnosis.

Lactate blood test taken and found to be very high.

After further discussion with radiology a CT angiogram was requested

The CT angiogram (CTA) demonstrates well the proximal SMA thrombus.  

The patient proceeded to theatre and had an open surgical thrombectomy of the SMA which confirmed the pathology.

Case Discussion

This case highlights the limitations of CT if the correct question is not raised. There are many ways to prepare a patients for CT, many different ways to administer contrast and many different ways to time IV contrast.

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Case information

rID: 39360
Case created: 1st Sep 2015
Last edited: 9th Sep 2015
Inclusion in quiz mode: Included

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