Introduction. Acute mesenteric ischaemia is often an undiagnosed pathology with an approximatively incidence of 1:1000 hospital admissions. Early diagnosis and prompt treatment are the aims of modern management of this pathology.
Case presentation. We present the case of a 65 years old male patient, recently diagnosed with low rate atrial fibrillation for which he received double antiplatelet therapy, who presented at the emergency room for continuous severe abdominal pain in the past hours. Computed tomography showed almost complete obstruction of superior mesenteric artery 4 cm from aortic origin. Due to lack of angiography during weekend, classic surgery was performed with extensive ileal resection and terminal-lateral jejunal-transverse anastomosis and closure of terminal ileum. After extensive small bowel resection, only 1 meter of jejunum remained. Postoperatively, a superior mesenteric artery catheter was mounted for continuous administration of heparin, that lead to an improvement of jejunal arterial blood supply. Postoperative outcome was favourable and the patient was discharged. The patient did not develop symptoms for Short Bowel Syndrome. Coumarin therapy was administered for both cardiac and surgical pathology with a therapeutic INR between 2 and 3. Computed tomography, 9 months after the initial surgery, showed complete re permeability of superior mesenteric artery.
Conclusions. Diagnosis and treatment of this pathology must be prompt due to severe prognosis of these patients. Surgical treatment is the method of choice in case angiography is unavailable. Local administration of heparin may increase survival rates of these patients.
Keywords: acute mesenteric ischaemia, surgical management, angiography.
University Emergency Hospital of Bucharest, University of Medicine and
Pharmacy “Carol Davila“, Bucharest, Romania
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