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‘’Dimo Narednikot’’ 89/39
Case report: Partial Occlusion of Superior Mesenteric Artery with Segmental Bowel Infarction
Gordana Antuleska-Belčeska1, Sonja Jovanoska2, Gordana Ljušič1
An acute superior mesenteric artery (SMA) occlusion, which results in acute mesenteric ischemia, is a life-threatening event due to the obstruction of the arterial supply of the majority of the small bowel and right side of the colon. An acute occlusion is an uncommon event that typically affects elderly patients who are at increased risk of other cardiovascular events. Clinical presentation is variable and unfortunately often non-specific, which may cause the delay in diagnosis. It may be dramatic, with an acute onset of severe abdominal pain or not well-defined symptomatology.
A 56-year-old male worker was admitted to hospital because of central abdominal pain. The pain which started two days before was atypical and not corresponding to physical findings. This started around the umbilicus and was non-radiating and not related to meals. The pain was associated with two attacks of non-bloody diarrhoea with no mucus. There was no history of urinary symptoms, fever or weight loss. The patient was hypertensive, on beta blockers, had no history of surgery or allergy and had no special habits. Physical examination revealed no evidence of arrhythmia or heart failure. Physical examination was significant only for marked generalized abdominal distension, tenderness and rebound tenderness. There were decreased bowel sounds, no ascites or organomegaly. The plain abdominal x-ray was normal. Ultrasonography examination revealed marked distension of the colon, as well as decreased peristalsis. Multi-slice computed tomography angiography of the abdomen revealed incomplete thrombosis of the SMA with secondary enhancement and wall thickening of the distal ileum, caecum and part of the ascending colon secondary to partial arterial occlusion (thrombosis).
We recommend that whenever mesenteric ischemia is suspected computed tomography angiography should be done because the routine computed tomography examinations may miss focal mesenteric artery occlusion. Decreasing the time to diagnosis remains the only reliable means to decrease the morbidity and mortality associated with this disease. Acta Medica Medianae 2014;53(1):53-57.
Key words: acute mesenteric occlusion, angiography, intestinal ischaemia