Superior mesenteric artery occlusion and small bowel ischaemia
Sudden onset of severe abdominal pain. Hypotensive and tachycardic with diffuse tenderness on examination. History of smoking and hypertension. ?ruptured abdominal aortic aneurysm.
Dual phase CT abdomen and pelvis
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There is no abdominal aortic aneurysm.
There are several loops of thin-walled, distended and fluid-filled small bowel with no appreciable enhancement of the bowel wall. A filling defect is present within the proximal superior mesenteric artery. There is a background of atherosclerotic disease but the coeliac axis and renal arteries enhance.
Due to the non-specificity of the clinical presentation, acute superior mesenteric artery thrombosis can be a challenging diagnosis to make and requires a low index of suspicion. There is usually a background of cardiovascular risk factors, and embolism is more common than in-situ thrombosis. The affected small bowel is thin-walled but distended due to loss of muscle tone of the bowel wall. It is uncommon for surgical confirmation of the diagnosis as this condition carries a high mortality.