Abstract
A 63-year-old man visited our emergency department because of sudden back pain, abdominal pain, and bilateral lower extremity weakness. Physical examination revealed a pulse deficit in the bilateral lower limbs, paraplegia, decreased tone of the anal sphincter, and left upper abdominal pain and tenderness. Abdominal computed tomography revealed an aortic embolism from the root of the right renal artery to the bifurcation of the iliac arteries and a mesenteric hemorrhage from the middle colic artery. An emergency laparotomy and bilateral Fogarty catheter embolectomy were performed simultaneously. After the surgery, he developed complications, namely paraplegia, renal failure, intra-abdominal abscess, and cytomegaloviral enteritis. However, he was well enough to be discharged.
Aortic saddle embolism is a critical disease characterized by sudden paraplegia with abdominal pain, back pain, and bilateral lower limb ischemia. Mortality can reach as high as 75% without appropriate surgical treatment. Mesenteric hemorrhage is a rare complication of saddle embolism. In this case, the mesenteric hemorrhage was considered to be due to the hemodynamic change caused by the aortic embolism, all of which were successfully managed with early diagnosis and appropriate emergency surgery.
