A Case of Acute Superior Mesenteric Artery Ischemia with an Atypical Clinical Course Due to the Presence of Collateral Blood Vessels

Abstract

A 78-year-old woman complaining of dyspnea and epigastric pain was brought to our hospital. Her vital signs were unstable, and she showed central cyanosis and evidence of severe acidosis. Contrast-enhanced computed tomography（CT）revealed an obscure contrast enhancement of the superior mesenteric artery, which made it difficult to identify the roots of the celiac and superior mesenteric arteries. Due to the wide ischemic region and poor general condition of the patient, we considered that surgery would be highly challenging. However, the following morning, the general condition of the patient was markedly improved. A repeat CT revealed improved intestinal blood flow and slightly better contrast of the root of the superior mesenteric artery. An angiography performed subsequently demonstrated collateral blood flow from the inferior mesenteric artery to the celiac and superior mesenteric arteries, which was considered to have maintained the intestinal blood flow in the superior mesenteric artery. After three months, the patient was discharged from the hospital. Acute mesenteric artery ischemia often requires urgent and invasive treatment, and only a few cases of non-invasive treatment for this disease have been reported in the literature. Herein, we report this rare case of non-invasive treatment, along with a brief review of the literature.