Endovascular therapy in acute mesenteric ischemia: a case report

Acute mesenteric ischemia (AMI) is a rare, sudden vascular event that unless diagnosed and treated very early, has a very high morbidity and mortality. Early diagnosis of AMI needs a high degree of clinical suspicion, especially if the patient is older than 50 years of age with cardiac disease. AMI can be due to superior mesenteric artery (SMA) emboli, non-occlusive mesenteric ischemia, SMA thrombosis, superior mesenteric venous thrombosis and focal segmental ischemia of colon. SMA occlusion by embolus or thrombus can be managed angiographically with aspiration of embolus, thrombolytics and stenting, non-occlusive mesenteric ischemia can be managed by vasodilator therapy with papaverine, nitroglycerine or prostaglandin E1, mesenteric venous thrombosis can be managed with anticoagulants while surgical methods like embolectomy, thrombectomy, arterial bypass and resection of infarcted bowel will be required in most cases, especially when signs of peritonitis develop. We report a case of proximal level superior mesenteric artery embolic obstruction that was diagnosed very early and managed by endovascular therapy with good success.