2023 Volume 43 Issue 5 Pages 923-926
A 79-year-old woman with chronic renal failure and atrial fibrillation presented to our hospital complaining of acute abdominal pain. Abdominal CT revealed a common bile duct stone. Because of renal dysfunction, we did not use contrast medium. However, the following day, the patient’s consciousness disturbance and abdominal pain worsened. Therefore, we performed abdominal contrast-enhanced CT under sodium bicarbonate solution administration to prevent contrast-induced nephropathy, which revealed thrombus occlusion of the superior mesenteric artery (SMA) and poor contrast enhancement of the small intestine wall. The patient was diagnosed as having acute SMA occlusion, and resection of a 410-cm segment of the small bowel was performed. Although she developed short bowel syndrome postoperatively, her life was successfully saved, and her renal function was preserved. In cases of atrial fibrillation presenting with acute abdomen, it is important to perform contrast-enhanced CT for accurate evaluation of the possibility of SMA.
