Superior mesenteric artery thrombosis

Case contributed by Dr István Kui

Presentation

Known chronic renal disease, presented with abdominal pain, diarrhoea followed by incontinence.

Patient Data

Age: 70 years
Gender: Male

Ultrasound

Modality: Ultrasound

Thrombus is demonstrated within an expanded SMA (arrows).

Modality: CT

CT arterial phase confirmed non-occlusive thrombus of the SMA.  Distal to the origin we can see a small filling defect, which grooves caudally, occluding 90% of the lumen (arrow).

Additional findings: free abdominal fluid (surrounding the liver and the spleen margins), thinning of both renal parenchyma, thickened and oedematous transverse colon, interlobar 3 cm liver cyst. Below the level of the origin of the SMA, filling defect in the right part of the aortic wall

Case Discussion

The superior mesenteric artery arises from the anterior surface of the abdominal aorta. Its branches include:

  • inferior pancreaticoduodenal artery
  • ileal and jejunal branches
  • ileocolic artery
  • right colic artery
  • middle colic artery

The SMA supplies the lower part of the duodenum, jejunum, ileum, ascending colon and the proximal two-thirds of transverse colon.

Acute occlusion of the SMA can lead to intestinal ischaemia and death. It can be classified as occlusive- or non-occlusive mesenteric arterial ischaemia. The occlusive form can be produced by mesenteric arterial embolism or by mesenteric arterial thrombosis. Occlusion of the SMA can also by precipitated by mechanical factors such as hernia with strangulation. Most of these cases are treated surgically (endarterectomy), but medical treatment with thrombolytic drugs is an alternative

In this case, non-occlusive SMA thrombus may be formed by primary thrombosis, precipitated by vessel atherosclerosis, or it could be formed by embolisation (we found thrombus on the aortic wall)

Our patient received anticoagulant therapy only and intestinal ischaemia didn't develop. The patients symptoms resolved and follow up with serial ultrasounds demonstrated a static thrombus without any further evolution.

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Case Information

rID: 48408
Case created: 5th Oct 2016
Last edited: 10th Oct 2016
Inclusion in quiz mode: Excluded

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