Superior Mesenteric Artery Occlusion by a Thrombus That Was Successfully Treated Using Interventional Radiology: A Case Report

Abstract

A thrombus in the superior mesenteric artery (SMA) is a critical condition that requires immediate diagnosis and treatment. We present a case of a thrombus in SMA that was successfully treated by interventional radiology. A 63-year-old male with a history of myocardial infarction, diabetes mellitus, hypertension, and gastric ulcers was admitted to our hospital complaining of severe upper abdominal pain. He had smoked 20 cigarettes per day for 40 years. Upon arrival, his blood pressure was extremely high (254/120 mm Hg). Noncontrast computed tomography (CT) revealed no apparent cause for his symptom. Electrocardiography revealed Q waves in V1 and V2 without ST elevation in other leads. Myocardial angina could not be ruled out. Immediately after the administration of heparin sodium, nicardipine, and nitrates, his symptoms alleviated. On day 2, upper endoscopy revealed multiple gastric ulcers, and a proton pump inhibitor was administered. On day 3, severe upper abdominal pain recurred. Contrast-enhanced CT revealed a thrombus in the proximal SMA. Prostaglandin E1 was intravenously administered. On day 4, abdominal angiography was performed, revealing an occluded thrombus in the proximal SMA with developed circulation in peripheral intestinal arteries. The thrombus was successfully resolved by arterial administration of urokinase and a balloon catheter. On day 5, postoperative CT revealed dilated small bowels. Subsequently, an ileus tube was inserted. The overall clinical course was uneventful, and oral feeding along with oral administration of aspirin and warfarin was initiated on day 18.

Acute superior mesenteric arterial thromboembolic occlusion-catheter directed thrombolysis-be on time, still be cautious!

“…5 The mortality rate of acute SMA occlusion remains high at 60 to 90%. 1,2,7,8 This high degree of mortality calls for a prompt evaluation and early management of acute mesenteric artery occlusion. Early intervention using endovascular therapeutic approaches have been reported with successful outcomes in fewer studies.…”

“…7 Emori et al have reported successful revascularisation of SMA thrombus following endovascular balloon angioplasty and thrombolysis. 2 According to us, endovascular therapy is a helpful initial strategy to reduce the bowel necrosis, provided it is agreed by the multidisciplinary team based on the clinical background and the surgical back up is ready to explore at the earliest sign of worsening.…”

“…The prognosis is poor with a high mortality rate of 60-80%. 1,2 The main etiology is cardiac emboli constituting 50% of the causes followed by pre-existing arterial plaque rupture resulting in sudden occlusion. 3,4 The other causes include prothrombotic conditions, non-occlusive causes and venous thrombosis.…”

Superior mesenteric artery thrombosis in a female patient with most probable cause COVID-19 vaccination: Case report

“…Early diagnosis of superior mesenteric artery occlusion is key factor to patients' survival. Unless treated within 10 -12 hours from onset it causes intestinal necrosis [6]. Treatment is surgical or intravascular restoration of blood flow to the intestine and removal of necrotic tissue [3].…”