A Case of Acute Superior Mesenteric Artery Occlusion with Mesenteric Arterial Gas Treated by Multimodal Rescue Therapy

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  • 集学的治療で救命した急性上腸間膜動脈閉塞・ガス血症の1例
  • 症例 集学的治療で救命した急性上腸間膜動脈閉塞・ガス血症の1例
  • ショウレイ シュウガクテキ チリョウ デ キュウメイ シタ キュウセイ ジョウ チョウ カンマク ドウミャク ヘイソク ・ ガス ケツショウ ノ 1レイ

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Abstract

Acute superior mesenteric artery (SMA) occlusion is generally considered to have a poor prognosis. In particular, such an occlusion associated with SMA gas embolism is very rare, and recovery from it has not been reported. A case of a 65-year-old woman with SMA gas embolism, who resumed her daily life following multimodal rescue therapy, is reported. She was initially referred to our hospital for acute epigastralgia. Multi-detector row computed tomography (MDCT) demonstrated a contrast defect in the SMA. On angiography, SMA occlusion was seen just after branching of the first jejunal artery, which was treated by thrombectomy and thrombolytic interventional therapy. Consequently, peripheral arteries from the SMA including the ileocolic artery restored the imaging effect through the marginal artery of the first to fourth jejunal artery, but simultaneous MDCT showed a small amount of portal venous gas. Close observation was maintained because of peripheral mesenteric artery enhancement. Two hours later, MDCT demonstrated gas embolism in the SMA, after which an emergency operation was performed. The jejunum to 20 cm in the ascending colon, corresponding to the range of SMA gas distribution, was resected. The patient is now alive, 1 year and 4 months after surgery. SMA gas embolism is a rare and severe condition, but appropriate surgery may lead to a good prognosis.

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