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SMA thrombus causing small bowel ischemia

Case contributed by Andrew Walker
Diagnosis certain

Presentation

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

Patient Data

Age: 55-60 years
Gender: Male

No cause for pelvic pain was demonstrated.

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

Ongoing lower abdominal pain led to further clinical review. Ischemic bowel was raised as a differential diagnosis, as suggested by radiology.

Serum lactate was found to be elevated.

After further discussion with radiology a CT angiogram was requested.

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

The patient proceeded to theater 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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