A Case of Acute Occlusion of Superior Mesentric Artery Treated by Intraoperative Angiography and Subsequent Thrombectomy

Takao Ohtsuka, Akira Nakagawachi, Tomonori Shimonishi, Kiyokazu Koga*, Yukio Okazaki*, Yuji Nakafusa and Kohji Miyazaki

Department of Surgery and Departement of Cardiovascular Surgery*, Saga University Faculty of Medicine

A 69-year-old man with untreated atrial fibrillation admitted for intermittent abdominal pain and bloody stool was found in computed tomography (CT) to have occlusion of the superior mesenteric artery (SMA). Laboratory data suggested intestinal necrosis necessitating emergency laparotomy. The jejunum and ileum were found to be ischemic but not necrotic. Intraoperative angiography showed the SMA to be occluded just distal to the first jejunal branch. Subsequent SMA exploration led to thrombectomy. The ischemic color of the small intestine recovered immediately after thrombectomy, as did pulsation of the blood supply to the small intestine. The postoperative clinical course of the patient was good. Our case demonstrates that intraoperative angiography is useful in evaluating the occlusion site in the SMA when the patient undergoes laparotomy with a diagnosis of intestinal necrosis and ischemic change is found to be reversible.

Key words
superior mesenteric arterial occlusion, intraoperative angiography, thrombectomy

Reprint requests
Takao Ohtsuka Department of Surgery, Saga University Faculty of Medicine
5-1-1 Nabeshima, Saga, 849-8501 JAPAN

Accepted
January 31, 2007

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