Acute Intestinal Ischemia Due to Thrombosis of the Superior Mesenteric Artery A Case Report and Review of Literature

Introduction: Acute mesenteric ischemia (AMI) is a rare medical condition with a prevalence of 0.1%. Difficult diagnosis and rapid disease progression can challenge clinicians in dealing with these cases. Case Report: An 87-year-old woman came to the emergency room with abdomen pain. Patient with a history of uncontrolled AF. Vital signs on arrival BP 100/70 mmHg, HR 100x/m, RR 20x/m, temp. 36.7 oC. Laboratory hemoglobin 12, leukocytes 42.6, neutrophils 89%, lymphocytes 10%, blood glucose 224 mg/dL. Physical examination showed tenderness throughout the abdomen with muscular defense and decreased peristalsis. Abdominal radiography showed free air appearing outside the intestinal contour with a continuous sub diaphragm sign and lateral decubitus sign. The patient decided to undergo an emergency exploratory laparotomy and intestinal ischemia (ileum) was found along 20 cm and thrombus along the mesentery artery. A 30 cm resection of the Treitz ligament was carried out followed by an end-to-end ileo-ileal anastomosis. Discussion: Clinical manifestations and supporting examination results of AMI are often unclear and difficult to distinguish from other acute abdominal symptoms. AMI management consists of initial management and surgical management. Initial management includes fluid resuscitation, electrolyte correction, and nasogastric decompression. After initial therapy, the patient in our case underwent emergency exploratory laparotomy with broad-spectrum antibiotic premedication. Keywords: acute mesenteric ischemia; thrombosis of the superior mesenteric artery