Ischemic bowel due to embolization from an isolated mobile thrombus of the ascending aorta: a case report and review of the literature

Abstract

Aortic thrombi are commonly present in atherosclerotic and aneurysmatic aortas. Thrombus formation in an aorta with or focal atherosclerosis in a patient without risk factors is rare. A 63-year-old woman with dementia and hypothyroidism presented with hypotension and respiratory distress. Work-up revealed leukocytosis, sinus tachycardia, and proximal small bowel obstruction. At emergent laparotomy, a superior mesenteric artery thomboembolus was identified with necrosis of surrounding bowel. The patient expired on hospital day five. Autopsy revealed a 1.4 cm thrombus overlying an isolated atherosclerotic plaque in the ascending aorta and infarctions of the spleen, liver, and right kidney as well as occlusive thromboembolism of the superior mesenteric artery. This case report illustrates lethal complications from an unsuspected aortic thrombus. Work-up for patients presenting with signs of peripheral embolization, or in this case, necrotic bowel, should include the aorta as a source of embolic thrombi.

Mesenteric ischemia: Pathogenesis and challenging diagnostic and therapeutic modalities

“…However, small bowel ischemia higher prevalence in patients with endovascular repair has been detected and is associated with extremely high mortality. The direct pathologic evidence and the patterns of seg mental, skipped, or patchy ischemia in most patients imply that microembolization plays a pivotal role [47,48] . CMI's management is mostly surgical.…”

Embolia sistémica a partir de placa aterosclerótica con trombo móvil aórtico: reporte de caso

“…Por otra parte, sitios infrecuentes de embolia a considerar son las dilataciones aneurismáticas aórticas, poplíteas, abdominales o embolia paradójica relacionada con comunicaciones cardiacas anormales (2)(3)(4) . Sin embargo, resulta de vital importancia tener en cuenta que la aorta es la fuente del 5 % de todos los casos de embolia y se relaciona frecuentemente con ateroesclerosis, factores de riesgo trombótico o instrumentación traumática (5) . A continuación se describe un caso de embolia arterial múltiple relacionado a placas ulceradas con trombos móviles en el cayado aórtico y aorta descendente.…”