Deimantė Bajoriūnaitė, Justinas Balčiūnas, Deividas Vaiciukevičius, Monika Jasinskaitė, Antanas Montvila
Acute mesenteric ischemia (AMI) is a rare cause for hospital admissions of abdominal pain with incidence of less than 0.1% but due to delay in diagnosis results in a high 40% to 80% mortality rate. Small intestine ischemia occurs due to blood supply interruption of the superior mesenteric artery (SMA) which can happen due to embolism, arterial or venous thrombosis or non occlusive ischemia. AMI is most commonly caused by SMA thrombosis, which is precipitated by dehydration, low cardiac output and hypercoagulation, or SMA embolic occlusion, which mostly occurs due to acute myocardial infarction. We present a 74-year-old man who complained of acute chest pain and pressure, black stools that started 4 hours ago. The patient had a history of prostatic hyperplasia and aortic surgery complicated by intestinal necrosis. Computed tomography (CT) showed bleeding in the duodenum, which was stopped using adrenaline. Coronary angiography was performed after cessation of bleeding. The patient began to complain of severe abdominal pain. Abdominal and pelvic contrast CT showed SMA thrombosis. The patient underwent small intestine resection, ileostomy and cystostomy. Histopathological examination revealed ischemic and necrotic changes. Despite the treatment the patient died. Physicians should be aware of AMI as a possible cause of abdominal pain, especially in elderly patients with cardiovascular comorbidities. Contrast enhanced CT should be the first-line imaging modality for differential diagnosis. Thorough assessment of symptoms and risks, timely use of diagnostic and interventional measures can help to reduce high mortality.
Keyword(s): acute mesenteric ischemia, superior mesenteric artery, intestine ischemia, mesenteric thrombosis.