A Case of Superior Mesenteric Artery Embolism with a Shaggy Aorta

Abstract

A woman in her 80s was admitted to our hospital with a history of abdominal pain which occurred after lunch. Abdominal CT revealed occlusion of the distal part of the superior mesenteric artery and a diffusely atherosclerotic aorta with ulcerated plaques. The patient was diagnosed as having embolism of the superior mesenteric artery and a shaggy aorta. We started the patient on conservative therapy with intravenous heparin infusion; however, her symptoms worsened. Therefore, we performed emergency laparotomy 18 hours later, and thrombectomy. Reperfusion of the superior mesenteric artery was achieved immediately after the procedure. However, the ileocecal region and jejunum remained severely ischemic, and both required resection. We conducted second-look and third-look operations to avoid excessive bowel resection. The final length of the residual bowel was approximately 200 cm and short bowel syndrome was avoided. Histopathological examination revealed cholesterin crystals in the embolus. We have presented a rare case of superior mesenteric arterial embolism due to cholesterin crystals released from a shaggy aorta.