Acute embolic occlusion of the superior mesenteric artery: a case report and discussion of management.
BACKGROUND
We present a case of acute embolus to the superior mesenteric artery (SMA).


METHODS
A 70-year-old gentleman with atrial fibrillation complained of colicky abdominal pain with clinical signs of tenderness and mild guarding.


RESULTS
Laparotomy revealed extensive bowel ischaemia but no overt infarction. The SMA was occluded by an embolus at the root of the mesentery and balloon catheter embolectomy was carried out at once. Bowel resection was deferred in order to allow clear demarcation of gangrene to avoid sacrificing unnecessary length. At second look laparotomy, 1.2 m of bowel from mid-jejunum to mid-ileum was resected, salvaging about 1 m of previously dusky small and large bowel.


CONCLUSIONS
This case illustrates the importance of accurate history taking, the role of early intervention and the usefulness of a second look laparotomy in cases of mesenteric ischaemia to minimise the extent of bowel resection.
Pasupathy
S
S
Vascular Surgery Unit, Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
Sebastian
M G
MG
Chia
K H
KH
D000368:Aged; D006801:Humans; D008297:Male; D012086:Reoperation; D013478:Superior Mesenteric Artery Syndrome / Q000175:diagnosis* / Q000601:surgery*