Acute Superior Mesenteric Artery Thrombosis Research Articles

Acute superior mesenteric artery thrombosis in a 34-year-old male with thrombophilia: a case report

Introduction: Thrombophilic state, marked by extensive formation of blood clots within the vascular system poses a formidable peril, leading to loss of circulatory integrity and systemic well-being. Superior mesenteric artery (SMA) thrombosis is a serious medical disorder characterized by the obstruction of the arterial blood flow to the gastrointestinal tract, which is associated with significant morbidity and mortality. The condition has a plethora of etiological causes. Vague abdominal pain is a common clinical manifestation, and there is a very high mortality rate.Case Presentation: A 34-year-old Pakistani male presented with rapidly worsening acute abdominal pain over a 10-hour period. Clinical examination revealed elevated blood pressure, while other vital signs remained within normal limits. Abdominal examination findings were inconclusive compared to the patient's severe abdominal pain complaint. Contrast-enhanced CT scan indicated a large thrombus in the superior mesenteric artery with radiological features suggestive of intestinal ischemia, extending from the duodeno-jejunal flexure to the mid-transverse colon. Subsequently, the patient underwent exploratory laparotomy with extensive bowel resection and received anticoagulant therapy. He subsequently experienced compensated right lower limb ischemia, treated conservatively with high-dose anticoagulant therapy. Within days, bowel anastomotic leak developed, requiring multiple surgeries. Eventually, the patient progressed to septic shock, followed by multiorgan failure, culminating in a fatal cardiac arrest.Conclusion: Acute mesenteric ischemia, a rare abdominal emergency with an incidence of 6 per 100,000, is associated with a substantial mortality rate, ranging from 58% to 93% among diagnosed cases. The challenges posed by SMA thrombosis include diagnostic complexities, as it frequently manifests with symptoms disproportionate to clinical signs, and results in catastrophic complications, necessitating high suspicion index and prompt intervention.

Thrombosis of acute superior mesenteric artery in a patient with breast cancer receiving toremifene therapy: a case report and literature review

It is widely recognized that cancer itself is related to increased risk of thromembolism. Venous thromboembolism is relatively common in breast cancer patients, but arterial thrombosis, especially acute superior mesenteric artery thrombosis (SMAT) associated with chemotherapy or endocrinotherapy, rarely occurs in breast cancer patients. There were few reports about acute SMAT in cancer patients who underwent chemotherapy, but no reports of acute SMAT caused by endocrine-therapy. We reported a 54-year-old patient with acute SMAT during toremifene treatment after breast cancer surgery. She underwent 4 cycles chemotherapy of TC regimen, then accepted toremifen endocrinotherapy because of positive estrogen receptor. She suffered from acute SMAT after 2 months toremifen treatment. Therefore, we consider that this case of acute SMAT may be a rare adverse event of toremifen. In view of the high risk and rarity of acute SMAT caused by toremifene, we suggest that except for venous thrombosis, arterial thrombosis in special position (ATSP) should be kept in mind during use of toremifene. Once a thrombotic event occurs, toremifene should be stopped immediately.

Acute Mesenteric Ischaemia: A Case Series

Acute Mesenteric Ischaemia (AMI) is a group of disorders characterised by a sudden occlusion of blood supply to varing portions of the small intestine, eventually progressing to ischaemia and peritonitis. The present case series highlights a total of seven cases, three of which are classified as acute superior mesenteric artery thrombosis and four as acute superiormesenteric vein thrombosis. The typically symptoms reported were sudden onset of abdominal pain, distension, and melena (a late finding). Among the seven cases, four patients who received early intervention had favourable outcomes. All patients presented late with peritonitis symptoms, except for one patient. Emergency laparotomy was performed on all patients, except for one who underwent diagnostic laparoscopy. Therefore, although abdominal pain is an uncommon symptom, physicians need to exercise a high level of diligence. If left untreated, the overall mortality rate consistently exceeds 70-90%. This case series emphasises the importance of timely diagnosis, early intervention, and immediate postoperative heparinisation, which significantly decrease morbidity and mortality.

Challenges in Diagnosing Acute Mesenteric Ischemia in a Patient with COVID 19

Extrapulmonary manifestations of COVID-19 including acute mesenteric ischemia are being increasingly recognized and associated with extremely poorer clinical outcomes. Because of unclear clinical presentation, non-specific early imaging, and laboratory findings, may lead to loss of valuable time. Considering the high thrombotic risk in COVID-19, it is crucial to consider the high suspicion of acute mesenteric ischemia in patients with acute abdominal pain. Here, we present a challenging case of an elderly female who developed an acute superior mesenteric artery thrombosis as a result of COVID 19.

Endovascular Approach to Acute Superior Mesenteric Artery Thrombosis Associated with Progesterone Use

We would like to report the case of superior mesenteric arterial thrombosis in a woman with a history of progesterone intake. A 51-year-old woman with a history of progesterone consumption for delayed menstrual cycles and menorrhagia, presented with severe abdominal pain, nausea, and a 1-day history of constipation. A contrast-enhanced computed tomography (CT) scan revealed near-total occlusion of 4.4 cm of the superior mesenteric artery from its origin ([Fig. 1]).

Endovascular Management of Acute Superior Mesenteric Artery Thrombosis in a Delayed Setting

Acute mesenteric ischemia [AMI] is a life-threatening situation, the diagnosis of which is often missed in early stages. Late diagnosis often precludes endovascular management as the primary treatment. The authors here present a case of seven days history of acute mesenteric ischemia in a young female, who not just benefited from endovascular management, but also a major surgical intervention was avoided andwas discharged from the hospital uneventfully. The decision to consider a patient for endovascular management in a late stage, requires a good interdisciplinary communication and successful outcome in such a scenario is rarely achieved.

T-ALL Presenting With Acute Mesenteric Ischemia

T-cell acute lymphoblastic leukemia is a rare and aggressive type of leukemia. We discuss the case of a 43 year old male who presented to the hospital with acute abdominal pain for one day. The patient reported waking up in the middle of the night with sudden onset nausea, vomiting and diffuse abdominal pain. The pain was constant, 10/10 and non radiating. The pain did not improve with narcotic medications. Physical exam revealed soft, non distended and mildly tender abdomen. The patient pain was “out of proportion” to the physical exam. Labs revealed pancytopenia and CT abdomen demonstrated acute superior mesenteric artery thrombosis. Exploratory laparotomy revealed necrotic bowel. The patient underwent multiple surgeries for revascularization and small bowel resection. Flow cytometry and bone marrow biopsy confirmed T-ALL. To our knowledge, this is the first case report of T-ALL presenting with acute mesenteric ischemia.2506 Figure 1. SMA thrombosis

Acute Superior Mesenteric Artery Thrombosis from Necrotic Pancreatitis as a Complication of Endovascular Abdominal Aortic Aneurysm Repair

Acute Superior Mesenteric Artery Thrombosis from Necrotic Pancreatitis as a Complication of Endovascular Abdominal Aortic Aneurysm Repair

Primitive neuroectodermal tumor/Ewing’s sarcoma of the urinary bladder: a case report and its molecular diagnosis

We report a rare case of primitive neuroectodermal tumor/Ewing's sarcoma (PNET/ES) arising from the urinary bladder. A 65-year-old man presented with hematuria and dysuria. Computed tomography revealed an enlarged invasive tumor at the base of the bladder. No additional abnormal findings were disclosed by other diagnostic imaging methods. The surgical specimens showed small round cell tumor with positive staining for MIC2 gene product (CD99). EWS-FLI1 fusion transcripts were detected by reverse transcriptase polymerase chain reaction and direct sequencing, confirming the diagnosis of PNET/ES. The patient developed swollen pelvic lymph nodes as well as multiple lung metastases at 8months postoperatively. No effective results could be obtained even with systemic chemotherapy consisting of vincristine, ifosfamide, doxorubicin and etoposide (VIDE) based on the EUROpean Ewing tumour Working Initiative of National Groups 1999 (EURO-E.W.I.N.G. 99) multinational trial. The patient died of acute superior mesenteric artery thrombosis at 22months postoperatively. PNET/ES could have been included in past cases of small cell carcinoma because of the difficulty in its differential diagnosis. Exact diagnosis is crucial for deciding the treatment strategy for rare bladder tumors consisting of small round cells.

Experience in the management of acute superior mesenteric artery ischemia

To study the management of acute superior mesenteric artery (SMA) ischemia and to improve its prognosis. The clinical data of 37 patients treated from January 1996 to August 2007 was retrospectively reviewed. Of the cases, 19 (51.4%) patients were diagnosed with acute SMA embolism, 15 (40.5%) with acute SMA thrombosis, 2 (5.4%) with spontaneous isolated dissection of SMA and 1 (2.7%) with SMA aneurysm. Nineteen (51.4%) patients were misdiagnosed in emergency. Eighteen (48.6%) patients died in the hospital, and most of them died of severe infection and multiple organ failure. Three cases of the survived 19 patients experienced severe complications (2 with short gut syndrome, 1 with cerebral hemorrhage). Nine cases were followed-up for a mean period of 15 months, and 5 died during that term. Acute SMA ischemia has multiple etiological factors. Early intervention can improve the prognosis.

Neoadjuvant preoperative chemoradiation in patients with pancreatic cancer

Purpose: To assess the toxicity and efficacy of preoperative chemoradiation in pancreatic cancer. Methods and Materials: Between November 1996 and December 2001, 32 patients with biopsy-proven pancreatic adenocarcinoma (28 head; 4 body) were treated by chemoradiation consisting of either split-course therapy (two courses of 15 Gy separated by a 2-week break, n = 10) or standard-fractionation therapy (45 Gy during 5 weeks, n = 22). Concurrent chemotherapy included continuous infusion of 5-fluorouracil and a cisplatin bolus. Pancreatic resection was scheduled for 4–6 weeks after completion of chemoradiation treatment. Results: All 32 patients completed the chemoradiation protocol. Only 2 cases of Grade 3 toxicity (weight loss, vomiting) and one fatal Grade 4 infection occurred. Of the 32 patients, 19 underwent curative resection. Two patients had a complete pathologic response. One patient died 36 months after diagnosis of late treatment-related toxicity (acute superior mesenteric artery thrombosis) with no evidence of disease. The 2-year overall survival rate for the entire group and the resected patients was 37.3% (95% confidence interval 18.2–56.4%) and 59.3% (95% confidence interval 34.1–84.9%), respectively. Conclusion: Preoperative chemoradiation with 5-fluorouracil and cisplatin is feasible and promising.

Acute superior mesenteric artery thrombosis due to stress erythrocytosis

Acute superior mesenteric artery thrombosis due to stress erythrocytosis