Superior mesenteric artery thrombosis

Case contributed by Dr Balint Botz

Presentation

Rapidly worsening abdominal pain, elevated WBC, CRP, PCT, D-dimer.

Patient Data

Age: 90 years
Gender: Female
  • Extensive filling defect in the superior mesenteric artery. 
  • Non-enhancing dilated small bowel with increased amount of gas intraluminally and also in the bowel wall. Note striking mesenteric and even portal venous gas indicating advanced ischemia, which also involves the proximal ascending colon. 
  • Small amount of pelvic free fluid. 
  • Other findings: signs of chronic kidney disease, severe atherosclerosis, status post cholecystectomy with resultant mild bile duct dilatation, sigmoid divertoculosis, advanced degenerative changes in the depicted skeleton including the right hip joint in particular. 

Case Discussion

During subsequent urgent laparotomy necrosis of the complete small bowel and the proximal ascending colon was found, and due to the condition being incompatible with life the operation was terminated, best supportive care was commenced. 

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