Superior Mesenteric Artery Thrombosis Research Articles

COVID‐19 with multi‐organ arterial and venous thrombosis. A case report

AbstractThis case illustrates a late complication of viral pneumonia, likely due to COVID‐19, characterized by simultaneous acute arterial and venous thrombosis in multiple organs. The patient experienced myocardial infarction with left ventricular thrombus, pulmonary embolism, acute limb ischemia, superior mesenteric artery thrombosis, renal artery thrombosis, and deep vein thrombosis, posing significant challenges in both management and determining the etiology.

A Rare Case of Peritonitis in a Patient on CAPD for Nine Years

We report a case of peritonitis due to multi-drug-resistant Escherichia coli in a patient with diabetic kidney disease on continuous ambulatory peritoneal dialysis for nine years. As the peritonitis did not resolve with conventional medical therapy, a contrast-enhanced CT was done, which showed superior mesenteric artery thrombosis with bowel ischemia. The peritoneal dialysis catheter was removed, and appropriate antibiotics were continued as per International Society for Peritoneal Dialysis guidelines. A year later, the patient while on maintenance hemodialysis presented with obstructive jaundice due to a growth in the ampulla of vater.

Peritoneal dialysis-associated peritonitis, caused by superior mesenteric artery thrombosis with intestinal necrosis: a case report.

Peritoneal dialysis (PD)-associated peritonitis is a common complication of PD. Enteric peritonitis is defined as peritonitis arising from an intestinal or intra-abdominal organ source. The delay in the diagnosis or treatment of enteric peritonitis has been reported to increase mortality. Therefore, the early consideration of enteric peritonitis, particularly in cases of culture-negative peritonitis, is imperative. A 67-year-old Japanese man who had been undergoing PD for 3years, was admitted to our hospital with a diagnosis of PD-associated peritonitis. A month previously, he experienced a bleeding gastric ulcer, which led to severe anemia (hemoglobin 6.3mg/dL), followed by thrombocytosis. On admission, peritoneal fluid analysis showed a high white blood cell count (WBC: 8,570 /µL), with neutrophils predominating (74.5%). Cultures of both his dialysis effluent and blood were negative. After admission, the WBC count of the dialysis effluent gradually decreased alongside antibiotic therapy, but the patient's abdominal pain did not improve. After 4days, enhanced computed tomography showed superior mesenteric artery (SMA) thrombosis and intestinal necrosis. Therefore, emergency intestinal resection and PD catheter removal were performed, and then antithrombosis therapy was initiated. Because the patient's abdominal pain was improved and platelet count and D-dimer concentration were reduced by these treatments, he was discharged from the hospital after 47days. Thus, we report a rare case of culture-negative PD-associated peritonitis, which was caused by SMA thrombosis and intestinal necrosis. It is likely that combination of severe calcification of SMA and prolonged thrombocytosis secondary to the severe anemia contributed to the thrombosis.

Percutaneous Mechanical Thrombectomy Using the AcoStream Thrombus Aspiration System for Acute Superior Mesenteric Artery Embolism

BackgroundThis study was performed to summarize our experience in treating acute superior mesenteric artery embolism (SMAE) by percutaneous mechanical thrombectomy (PMT). MethodsBetween January 2023 and October 2023, 18 patients presenting with acute mesenteric ischemia (AMI) were admitted to our center, including 11 cases of superior mesenteric artery embolism (SAME), 3 cases of superior mesenteric artery thrombosis (SMAT) and 4 cases of superior mesenteric vein thrombosis (SMVT). We retrospectively reviewed 8 patients (4 males and 4 females; range, 51–79 years; mean, 62.50 ± 9.67 years) who underwent treatment of acute SMAE using the AcoStream system. The patients had no obvious evidence of intestinal necrosis as shown by peritoneal puncture or computed tomography (CT). Thrombectomy was performed on the superior mesenteric artery (SMA) using an 8F AcoStream thrombus aspiration system (Acotec, China). The demographics, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. ResultsThe technical success rate was 100%. After 1-3 passes (2.38 ± 0.92) and aspiration thrombectomy, complete thrombus removal was achieved in 7 (87.50%) patients. 1 patient received an adjunctive catheter-directed thrombolysis (CDT) due to partial thrombus removal. Thrombolysis was conducted for 2 days, resulting in complete resolution of the thrombus. The other 7 patients did not receive adjunctive endovascular intervention due to complete thrombus removal and no residual stenosis. No distal embolization or device-related complications were noted during the procedure. After the procedure, sufficient clinical improvement was seen in 6 patients within 1-2 days. 2 patients showed no significant improvement of their symptoms. Laparotomy was performed on day 1 and day 2 after thrombectomy in patients 3 and 7, respectively. Intestinal necrosis was diagnosed operatively and intestinal resection was performed. All patients were discharged 6–15 days (9.50 ± 3.07) after admission without perioperative complication or death. The mean follow-up period was 5.00 ± 3.30 months (range, 1-10 months), and the follow-up rate was 100%. During the follow-up, all patients remained symptom-free. CTA images showed good flow in the trunk and branches of the SMA in all patients. ConclusionsPMT using the AcoStream system is a minimally invasive, safe, and effective technique for acute SMAE. Early application of PMT can achieve immediate revascularization of the SMA and have the potential advantage of avoiding laparotomy or reducing the extension of enterectomy, as it could theoretically restore intestinal perfusion in less time than open revascularization. If the symptoms do not improve after PMT, exploratory laparotomy should be scheduled as soon as possible. Further studies are necessary on this field to confirm these findings.

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.

Superior Mesenteric Artery Thrombosis and Intestinal Ischemia in Chronic Kidney Disease

We describe the case of an elderly female with a complex medical history, including hypertension, chronic kidney disease, hypothyroidism, and multiple cardiovascular and pulmonary conditions, who presented to the emergency department with abdominal pain. Due to the patient’s chronic kidney disease, two non-contrast CT scans initially ordered showed unremarkable results. The decision to order a third CT scan with contrast finally demonstrated a thrombus in the superior mesenteric artery with potential bowel ischemia. The patient’s condition deteriorated rapidly during the discovery of mesenteric artery thrombosis and extensive gangrenous bowel during surgery. Due to the irreversibility of the bowel ischemia, the patient was placed on comfort measures and passed away.

Spontaneous dissection of celiacomesenteric trunk with isolated extension and thrombosis in the superior mesenteric artery: a case report and literature review

BackgroundCeliacomesenteric trunk (CMT) is one of the rare congenital anomalies of the splanchnic vasculature, characterized by the common trunk origin of the superior mesenteric artery (SMA) and celiac trunk from the abdominal aorta. Dissection of CMT with isolated SMA involvement without bowel ischemia has been rarely reported in the literature.Case presentationA 48-year-old male presented with generalized abdominal pain for 20 days, which increased after food intake. He also gave a history of passing loose stools on and off in the last 10–15 days, associated with melena for 4–5 days. Computed tomography (CT) and CT angiography (CTA) study of the abdomen demonstrated the common trunk origin of SMA and celiac trunk from the abdominal aorta at the D12–L1 disk level, consistent with the celiacomesenteric trunk (CMT). CTA also revealed dissection of CMT with isolated extension in the SMA origin and thrombosis in the mid and distal SMA. No bowel or mesenteric ischemia was seen due to extensive collateral supply to distal-most SMA and its branches, mainly through the inferior mesenteric artery (IMA) via an arc of Riolan and artery of Drummond. The patient was managed conservatively with bowel rest, anti-thrombolytics, and anticoagulant therapy based on imaging findings of short-segment dissection with no signs of bowel or mesenteric ischemia.ConclusionDiagnosis of rare vascular anomalies like CMT with associated complications of dissection and thrombosis is critical in patients with abdominal pain for prompt and precise management. CTA of the abdomen is essential for accurate diagnosis and characterization of the abnormality, which helps decide between conservative and surgical treatments.

Retraction: Superior Mesenteric Artery Thrombosis Following Severe COVID-19 Pneumonia.

[This retracts the article DOI: 10.7759/cureus.19954.].

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.

Spontaneous Renal Artery, Superior Mesenteric Artery and Distal Splenic Artery Thrombosis: An Unusual Case of Acute Abdomen

Spontaneous Renal Artery, Superior Mesenteric Artery and Distal Splenic Artery Thrombosis: An Unusual Case of Acute Abdomen

SARS-COV-2-related superior mesenteric artery thrombosis resulting in pneumatosis intestinalis complicated by pneumatosis portalis in a young male: a case report.

The novel coronavirus disease-2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 is a highly contagious disease that has rapidly spread throughout the world. In addition to respiratory complications, the virus has also been linked to damage other organ systems as well as coagulopathy. The features and clinical spectrum of COVID-19 are continually emerging, with growing evidence of its connection to thrombosis in various systems. In this case report, the authors present a case of COVID-19 infection in a young male patient who had superior mesenteric artery thrombosis with pneumatosis intestinalis complicated by hepatic portal venous gas.

Post COVID Thrombotic Sequelae: Once Bitten, Twice Shy!

Introduction Long Covid has been recognized as a distinct entity with thrombotic sequelae [1]. Persistent systemic vascular inflammation caused by thrombosis drives the complications associated with long COVID. The risks of arterial and venous thrombosis after COVID-19 extend well beyond the hospitalization period. Early prophylactic anticoagulation has been shown to reduce the incidence of post-covid thrombotic sequelae [2]. Some evidence suggests the use of a higher than prophylactic dose for primary venous thromboembolism prophylaxis, especially in patients with a history of venous thromboembolism (VTE) [1]. We present a case of long Covid who developed recurrent thrombosis despite being on a therapeutic dose of anticoagulation. Case Presentation A 55-year-old male was brought to our Emergency Department with complaints of diffuse abdominal pain and black-coloured stools for three days. Contrast-enhanced CT abdomen (CECT) showed distal superior mesenteric artery (SMA) thrombosis and splenic infarct (Figure 1). He was treated for mild Covid-19 infection three months back. History also revealed he was hospitalized two months ago with a diagnosis of non-ST segment elevated myocardial infarction (NSTEMI) and acute ischemic stroke (Figure 2), which was managed with antiplatelets, statins and anticoagulants. He was discharged on oral anticoagulants (Tab Rivaroxaban 15 mg twice daily) for three months and was on regular follow-up. There was no history of smoking or hypertension. Protein C, Protien S, homocysteine levels were normal. After the diagnosis of SMA thrombosis, his anti-coagulation was increased to Tab Rivaroxaban 20 mg twice daily. No further thrombotic episodes have been noted as of date. Discussion This case suggests that unexplained repeat thrombotic events at multiple sites may have been a consequence of Covid-19 infection. Covid-19 patients experience both arterial and venous thromboembolism [3]. Most commonly, the former presents as myocardial infarction and ischemic stroke, whereas the latter as deep venous thrombosis and pulmonary embolism. Mechanisms include changes in lung structure secondary to chronic hypoxia, persistent immune dysfunction, and endothelial damage [1]. Risks of thrombotic events after mild Covid-19 are less clear, with the need and intensity of prophylactic anti-coagulation in this subset of patients being a matter of future research [4]. Shabaka et al. have shown that patients with a history of Covid-19 infection and previous thromboembolic events were at higher risk of developing a repeat thrombotic event [5]. Physicians need to be vigilant about the thrombotic events in patients with long Covid, even in patients receiving therapeutic anti-coagulation. Such patients require more frequent monitoring for signs of thrombotic events, risk factor management, and adherence to preventive therapies [3].

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.

560: A CASE REPORT ON SUPERIOR MESENTERIC ARTERY THROMBOSIS IN A COVID-19 PATIENT

Introduction: This case report discussed and reviewed an atypical presentation of COVID 19 involving superior mesenteric artery thrombosis with associated ischemic colitis. Thrombosis had been reported in up to 50 percent of patients with severe COVID -19. The pathophysiology of thrombosis in COVID 19 infection may include increasing blood viscosity and endothelial damage. Description: Case: A 59-year-old male with GERD, hiatal hernia, and diverticulitis was presented with ten days history of abdominal pain and vomiting, which later became coffee ground in nature. He was diagnosed with COVID 19 seven days before his presentation. Lab work showed hypokalemia with lactic acidosis, polycythemia, leukocytosis, thrombocytosis, and elevated D dimer. Esophagogastroduodenoscopy demonstrated actively bleeding Mallory Weiss tear successfully treated with bipolar circumactive probe cautery (BICAP). The patient’s abdominal pain worsened, and a repeat CTA abdomen revealed a superior mesenteric artery thrombosis with thickening of the distal small bowel and ascending colon. Vascular surgery was consulted, and performed catheter-assisted tPA thrombolysis to the SMA. Atrial fibrillation, diverticulitis, and other possible causes were eliminated as etiologies. Discussion: Acute mesenteric ischemia is a rare abdominal emergency. Due to rapid deterioration, early diagnosis and treatment are momentous for management. Severe abdominal pain and hematemesis are the keys to starting the evaluation. Initial investigation should include basic labs with a coagulation profile; the most common abnormalities are polycythemia, metabolic acidosis, lactic acidosis, and leukocytosis. CTA provides exquisite detail of the vascular anatomy and beneficial information regarding other bowel pathologies. After diagnosis, definitive management with fluid resuscitation, antibiotics, and IV high dose unfractionated heparin, if not contraindicated, should be initiated immediately. Recently, catheter-directed procedures for intravascular thrombectomy have been used with tPA. CONCLUSION: In our case, we attempted to emphasize the importance of a high index of suspicion with proper history, physical examination, and appropriate imaging for proper diagnosis and management of this life-threatening incident.

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.

S3516 A Case of Recurrent Thromboangiitis Obliterans (Buerger's Disease) in a Patient With Abdominal Pain and Intestinal Transplant

Introduction: We describe a case of abdominal pain and recurrent disease following intestinal transplant in a patient with a history of mesenteric ischemia and Thromboangiitis obliterans (Buerger's syndrome) that did not resolve with standard medical therapy. Case Description/Methods: A wonderful 44 year old female presents with intestinal infarction. The patient required three prior revascularization procedures with acute on chronic mesenteric ischemia with superior mesenteric artery thrombosis. She was taken to the operating room for necrotic small bowel with resection 20 centimeters distal to the ligament of treitz and placed on parenteral nutrition. Following recurrent episodes of line related bacteremia and fungemia she was listed for intestinal transplantation. After being off tobacco for a year she received and small bowel and right colon transplant. She had initial anticoagulation which was restarted four year later after a deep venous thrombosis to the lower extremity. Seven years following transplant the patient had inconsistent use of the anticoagulation along with recurrent tobacco abuse and developed recurrent mesenteric ischemia with acute on chronic occlusion of the celiac trunk, superior mesenteric artery, and inferior abdominal aorta leading to generalized abdominal pain, ischemic colitis and septic shock. Given recurrent abdominal infections patient had enterectomy 8 years and six months following intestinal transplantation. The patient subsequently developed bacteremia, candidemia and line related thrombosis. Patient had eventual transition to palliative management and died. Discussion: Buerger's disease (also known as thromboangiitis obliterans) affects blood vessels in the body, most commonly in the arms and legs. The use of tobacco is essential for both the initiation and progression of this disease. Blood vessels swell, which can prevent blood flow, causing clots to form. This can lead to pain, tissue damage, and even gangrene. It is typically treated with medications that dilate blood vessels, improve blood flow or dissolve blood clots, such as anticoagulants. Ongoing tobacco cessation is vital to success following rare intestinal transplantation. We present a case of intestinal transplant for Buerger’s Disease with recurrent thrombosis seven years following intestinal transplant attributed to recurrent tobacco abuse.

S3483 Superior Mesenteric Artery Thrombosis and Intestinal Ischemia as a Consequence of Sars-Cov-2 Infection

S3483 Superior Mesenteric Artery Thrombosis and Intestinal Ischemia as a Consequence of Sars-Cov-2 Infection

P142 Lodderomyces elongisporus: A n emerging cause of fung emia

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMBackground Lodderomyces elongisporus, earlier considered as a sexual state of Candida parapsilosis, was described as a distinct species based on ribosomal RNA gene sequencing. Few cases of human infections by this yeast have been described from Mexico, China, Malaysia, Kuwait, Australia, and the USA. We describe here eight cases of fungemia by L. elongisporus from a tertiary care hospital in North India.MethodsClinical characteristics and risk factors associated with L. elongisporus fungaemia were evaluated. Yeast isolated from blood culture (BD BACTEC™ 9240, New Jersey, USA) was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectroscopy (MALDI-TOF MS, Bruker Daltonik GmbH, Bremen, Germany) and sequencing of D1/D2 region of a large subunit of ribosomal DNA. We performed antifungal susceptibility testing for amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, caspofungin, anidulafungin, and micafungin by the microbroth dilution method recommended by the Clinical and Laboratory Standards Institute (CLSI).ResultsWe report eight cases of fungemia caused by L. elongisporus at our tertiary care center. Of these, three were infants (males) and five were adults (3 males and 2 females). The mean age of adults was 43.4 years. Among the pediatric cases, underlying diseases included congenital heart disease/atrophic kidney (neonate), tracheoesophageal fistula (4 months), and late-onset neonatal sepsis (LONS). Among the adults, underlying illnesses included acute kidney injury (n = 2), superior mesenteric artery thrombosis with bowel gangrene (n = 1), diabetes (n = 1), and central nervous system (CNS) lymphoma (n = 1). The iatrogenic factors included the history of surgery (n = 3), admission to ICU (n = 3), presence of urinary catheter (n = 4), and presence of central venous catheter (n = 1). Seven patients were on broad-spectrum antibiotics. The mean stay in the hospital was 20.38 days. Three of the patients were managed with fluconazole. Six patients improved while one left against medical advice (LAMA) and one expired. The range of minimum inhibitory concentration (MIC) of all the isolates against antifungals was as follows: amphotericin B (0.03-0.25 μg/ml), fluconazole (0.125 μg/ml), voriconazole (0.03 μg/ml), itraconazole (0.03-0.06 μg/ml), posaconazole (0.03-0.25 μg/ml), caspofungin (0.03-0.06 μg/ml), micafungin (0.03-0.06 μg/ml), and anidulafungin (0.03 μg/ml).Conclusion Lodderomyces elongisporus is an emerging pathogenic yeast causing fungemia in patients with comorbidities and undergoing surgery or invasive interventions. Though no antifungal breakpoints exist for this yeast, all the isolates exhibited low MICs to all the tested antifungals.

Precise diagnosis of acute mesenteric ischemia using indocyanine green imaging prevents small bowel resection: A case report.

IntroductionAcute mesenteric ischemia (AMI) is a rare life-threatening condition that causes intestinal necrosis. Prompt intervention is essential to mitigate high mortality. In this report, we describe a case of AMI where precise diagnosis using indocyanine green (ICG) imaging to confirm sufficient bowel perfusion and viability, helped in preventing intestinal resection.Presentation of caseA 91-year-old male was diagnosed with AMI associated with superior mesenteric artery thrombosis using computed tomography and underwent exploratory laparotomy. Under white light, there was no outward evidence of small-bowel necrosis. Hence, ICG was used to confirm adequate bowel perfusion and viability. The operation was terminated without resection of the small intestine. When anticoagulation therapy was initiated postoperatively, the thrombus subsided. Although the patient had no subsequent recurrence, he died of dysphagic pneumonia two months after the surgery.DiscussionPhysicians often choose to perform trial laparotomy to diagnose intestinal ischemia due to AMI.However, it was difficult to assess the viability of the entire intestinal tract using white light alone, and the introduction of ICG in the evaluation of intestinal perfusion will facilitate the identification and objective evaluation of the intestinal ischemic zone. There have been few reports on application of fluorescent-guided determination of the viable zone of the small intestine, which will help surgeons to make precise diagnosis.ConclusionThis case demonstrates ICG fluorescence imaging as a useful method for objectively assessing bowel viability.

Superior Mesenteric Artery Thrombosis as a Complication of COVID-19 Pneumonia: A Case Report

Superior Mesenteric Artery Thrombosis as a Complication of COVID-19 Pneumonia: A Case Report