Air Embolism into Superior Mesenteric Artery Following Replacement of Ascending Aorta for Aortic Dissection – A Rare and Fatal Case

Abstract

We report an unusual case of fatal air embolism into the superior mesenteric artery in a patient, who underwent replacement of the ascending aorta for aortic dissection type A. CT performed twice on the first postoperative day showed abundant air in the superior mesenteric artery and its branches (but not in the portal-venous system) indicating air embolism with no signs of bowel necrosis. On the second postoperative day, the patient underwent extensive bowel resection due to bowel ischemia and died on the third postoperative day on MODS/SIRS.

Unusual computed tomography findings of gas in the superior mesenteric artery system with no signs of porto-mesenteric venous gas in a case of acute mesenteric ischemia

“…To the best of our knowledge, the presence of gas exclusively in the SMA mesenteric arterial district as a consequence of AMI, without the involvement of the porto-mesenteric venous system, has thus far not been reported. Gas in the SMA has been described as a complication of sepsis with Disseminated Intra-Vascular Coagulation (DIC) [8] , as a form of gas embolism as a major complication of acute aortic dissection, and following the replacement of the ascending aorta for aortic dissection [ 9 , 10 ], although always in association with porto-mesenteric venous gas.…”

Could CT finding of gas in the sole mesenteric artery be a sign of a severe acute ischemia? Presentation of a rare fatal case and a literature review

“… [20] 51, F acute abdominal pain - Acute type A aortic dissection with multiple malperfusions of the vessels and gas in the superior mesenteric artery Emergency aortic replacement Death soon for massive bowel necrosis Lambert et al. [21] 50, M - ↑ Lactate ↑ Creatinine CT performed twice on the first postoperative day—replacement of the ascending aorta for aortic dissection type A—showed abundant air in the superior mesenteric artery and its branches (but not in the portal-venous system) indicating air embolism with no signs of bowel necrosis. Extensive bowel resection the day after Death the day after on MODS/ SIRS Fujiwara et al.…”

“…Two cases reported AMI as a complication of surgery for type A aorta dissection. Visceral vessel stenosis [20] or iatrogenic embolism [21] was described; in both cases, gas in the SMA was found, while evidence of bowel wall necrosis occurred only in the following days [ 20 , 21 ].…”

Superior Mesenteric Artery Dissection After Lumbar Puncture

“…As Prabhakar et al previously established, a middle colic artery connecting to the splenic flexure can lead to this event, if anatomically positioned in relation to the possible LP approach we can topographically project a point between this anatomic variant, the spleen and the spinal cord, since the aorta was avoided and the CT scan showed a SMA dissection [2]. Our patient had inadvertently underwent LP at the higher level, which possibly can cause the event; the clinical features that most patients present with SMA dissection are severe abdominal pain associated with nausea, vomiting, abdominal distension and melena [11]. Moreover, other possibility can also be the spontaneous dissection of the SMA [12][13][14][15].…”