A Case Report of Acute Superior Mesenteric After Occlusion Treated by Embolectomy

Superior mesenteric artery occlusion is treated by resection of the infarcted bowel in almost all cases. Recently we encountered a patient suffering from a superior mesenteric artery embolus. The patient was a 51 year old man in whom had been pointed out hypertension, diabees mellitus and an old myocardial infarction. The onset was abrupt with severe abdominal pain. Although melena occurred post admission, endoscopy revealed no evidence of bleeding from the stomach, duodenum or colon. Ultrasonography revealed a cardiac aneurysm. The physical findings and symptoms suggested the exsistence of obstruction of mesenteric vessels. On superior mesenteric angiographic examination, a shadow defect appearance was noted. Urokinase was infused continiously for 24 hours (10, 000 U/hr) by an arterial infusion pump through selected catheterization to the SMA. Repeated angiography showed persistent occlusion. Then surgery was performed. After embolectomy using a Fogarty's balloon catheter, a striking improvement in bowel color and marginal pulsation took place. Bowel resection was not necessary.