2003 Volume 23 Issue 5 Pages 795-798
A 78-year-old man referred for acute abdomen was found on physical examination to have a soft abdomen without distension, generalized severe pain, and weak bowel sounds. Abdominal X-ray did not show an abnormal silhouette. Electrocardiography showed arterial fibrillation. When conservative therapy did not relieve abdominal pain, we conducted emergency CT and selective angiography of the superior mesenteric artery (SMA), which showed occlusion of the middle colonic artery. Under a diagnosis of SMA embolism, we conducted emergency surgery 34.5 hours after onset. Intraoperative findings showed no intestinal necrosis, so we conducted embolectomy at the furcation of the middle colic artery without intestinal resection. Acute SMA embolism as seen in this case is very rarely treated successfully with vascular reconstruction alone after 34.5 hours has elapsed. The intestinal golden time is thus influenced bythe site and spread of occlusion or the condition of mesenteric circulation.
