A CASE OF SUPERIOR MESENTERIC ARTERY EMBOLISM WITH MULTIPLE ARTERIAL OCCLUSION INVOLVING THE LEFT LOWER EXTREMITY, LIVER, SPLEEN, AND BILATERAL KIDNEY

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  • 上腸間膜動脈塞栓症に対する大量腸管切除後に多発動脈塞栓症を合併した１例

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Abstract

A 72-year-old woman who had been treated for paroxysmal atrial fibrillation was brought into the hospital by ambulance because of abdominal pain and distension. When she arrived at the hospital, she was in a shock state with blood pressure of 80mmHg and impaired renal function. Plain CT scan showed ascites and dilatation of the small intestine. Emergency laparotomy was performed 4 hours after her arrival. A diagnosis of superior mesenteric artery embolism was made, and almost the entire small intestines and right colon which were necrotic were resected. Three days after the operation, she complained of severe pain of her left lower extremity. A diagnosis of acute arterial occulusion was made, and thromboembolectomy for the left lower extremity was performed. After the second operation, anticoagulation therapy with heparin was started. Two weeks later, abdominal CT scan revealed multiple infarction of the liver, spleen and bilateral kidney, indicating so-called shower embolism. She was discharged from the hospital on 47th postoperative day. In the treatment of the ischemic intestine with atrial fibrillation, early start of anticoagulation therapy with heparin is essential for prevention of recurrence or multiple occurrence of arterial thrombosis after the operation.

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