2020 Volume 40 Issue 7 Pages 831-834
The patient was a 63–year–old man who developed abdominal pain of sudden onset and was transported to the emergency department of our hospital. Contrast–enhanced abdominal computed tomography revealed an extravasation of superior mesenteric artery (SMA). He was diagnosed as having hemorrhagic shock, and hemostasis, transverse colectomy and ileostomy were performed on the same day. The hemorrhagic shock recurred two days after the operation, and contrast–enhanced abdominal computed tomography revealed SMA occlusion and poor contrast enhancement over the intestine. Resection of most of the small intestine and right hemicolectomy and a re–ileostomy were performed. The histopathological diagnosis of the resected specimen after the first operation was segmental arterial mediolysis (SAM), and that after the second operation was intestinal obstruction caused by a fresh thrombus and intestinal necrosis. We encountered a very rare case of a patient with thrombosis of the SMA occurring after operation for intraperitoneal bleeding from the SAM who we were able to rescue. We report this case to underscore the necessity to bear in mind the risk of obstruction of blood flow by thrombosis after hemostasis.
