2019 Volume 39 Issue 3 Pages 515-518
A 67-year-old female, previously treated for arterial fibrillation with warfarin, was transferred to our hospital because of sudden abdominal pain, nausea, and vomiting. A CT scan showed a superior mesenteric artery (SMA) obstruction and small bowel ischemia. She was treated with transcatheter arterial injection of urokinase, and abdominal exploration. Twenty cm of necrotic small intestine was resected and the color and motility of the remnant intestine was intact. Seven days after the first operation, she complained of abdominal pain and fever. No ischemic changes of the remnant small intestinal ischemia were detected on CT imaging, but a small intestinal enema revealed mucosal necrosis. We decided to carry out a second exploration. The remnant intestine exhibited good pulse, color, and motility, but its circumference was unclear and we detected a stricture during intraoperative endoscopy. The resection line was detected using endoscopy, followed by repeat resection, to obtain as short a remnant as possible. Based on the histopathological findings, the patient was diagnosed as having an ischemic stricture of the small intestine. We report herein on a case of ischemic stricture of the small intestine after SMA thrombosis. A small intestinal enema was useful for diagnosis, and we determined the resection line with intraoperative endoscopy.
