A Case Report of Acute Hepatomesenteric Superior Mesenteric Arterial Oclusion

Shinya Adachi, Takahiko Kawashima, Isamu Morishima, Azusa Ozaki

Department of Surgery, Kinu Medical Association Hospital

A 67-year-old man had been treated for inferior myocardial infarction of 3 months' duration after long-term medication for unstable angina. He was admitted to our hospital because of severe abdominal pain, melena and diarrhea of 4 days'duration. Emergency laparotomy revealed occlusion of the superior mesenteric artery (SMA) and necrosis of the small intestine for 1 m 50 cm in length. After thrombectomy, bowel resection was performed. Postoperative angiography revealed hepatomesenteric branching (the common hepatic artery branching from the SMA), occlusion of the bilateral internal iliac arteries and the left gastric artery, and stricture of the left renal artery and a jejunal artery. Urokinase (240,000 U) was infused into the SMA. After 2 months, angiography revealed patent superior mesenteric circulation. We reported a rare case of acute occlusion of the hepatomesenteric SMA.

Key words
occlusion of superior mesenteric artery, anatomical variation of superior mesenteric artery, occlusion of common hepatic artery

Reprint requests
Shinya Adachi Kinu Medical Association Hospital
13-3 Araigi-cho, Mitsukaido-shi, 303 JAPAN

Accepted
January 13, 1993

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