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). Non-contrast 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.




J Med Cases. 2017;8(3):81-85
doi: https://doi.org/10.14740/jmc2746w