Abstract
We report a case of acute superior mesenteric artery (SMA) embolism treated in a second-look procedure after embolectomy. A 69-year-old man with a 10-year history of hypertension and atrial fibrillation admitted for sudden onset of severe abdominal pain was found on admission to have spontaneous pain throughout the abdomen, a weakened intestinal murmur, and tenderness in the upper abdomen. Contrastenhanced CT showed a low-density area in the SMA. SMA angiography showed complete occlusion of the SMA trunk. Transcatheter infusion of urokinase had no effect. Emergency laparotomy was done 8 hours after onset. The moderate segment of the intestine showed cyanotic change, necessitating embolectomy of the SMA. About 24 hours after embolectomy, a second-look procedure showed the small intestine near Treitz's ligament to be necrotic for 220cm, necessitating resecction of the necrotic small intestine with a primary anastomosis. The patient was discharged 1 month after surgery. The second-look procedure is thus recommended in patients with equivocal viability of the bowel after revascularization.
