An Emergent Management of Acute Superior Mesenteric Artery Embolism With Ileal Gangrene

Abstract

Acute mesenteric ischemia (AMI) occuring due to sudden, partial or complete interruption of blood ow in main visceral arteries of the abdomen eventually resulting in intestinal ischemia and/or bowel gangrene is a surgical emergency. It represents 0.1% of hospital admissions and 2% of the revascularization operations for atheromatous lesions. 50% of AMI is caused by embolic phenomenon, 25% by thrombotic episode and rest 25% by both. The most common vessel involved in AMI is superior mesenteric artery. Acute mesenteric embolic ischemia (AMEI) arises typically from a cardiac emboli in patients with atrial brillation or following MI. Patients usually presents with central abdominal pain, out of proportion to the physical ndings initially, later becoming diffuse associated with bloody diarrhoea during the episode. An early diagnosis, an aggressive resuscitation, intravascular or surgical restoration of blood ow and subsequent bowel resection based on bowel viability helps reduce morbidity and mortality.