2025 Volume 45 Issue 4 Pages 449-452
Superior mesenteric artery (SMA) embolism is associated with sudden intestinal ischemia, resulting in sudden abdominal pain. A 49-year-old man with a history of atrial fibrillation presented to us with the chief complaint of acute abdominal pain. Contrast-enhanced computed tomography of the abdomen revealed SMA embolism and emergency surgery was performed. Necrosis of the intestine was observed in a region about 20 cm distal to the ligament of Treitz. A terminal ileum-preserving small bowel resection and ileostomy were performed. Management of nutrition and fluid intake is difficult in patients with short bowel syndrome (SBS) developing after surgery. The patient was discharged from the hospital after introducing home parenteral nutrition. Postoperative exacerbation of fatty liver was observed, and the patient could not return to work due to the time required for parenteral alimentation. Therefore, ileostomy closure was performed four months after the initial surgery, and the oral small intestine and terminal ileum were anastomosed; the length of the remaining small intestine was 25 cm. The patient was able to resume intake of a normal diet, and the dose of parenteral alimentation was reduced. No further exacerbation of fatty liver was observed, and the patient could return to work. In cases of SBS where the terminal ileum can be preserved, ileostomy closure may improve the quality of life of the patients.
