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A 76-year-old woman with a history of atrial fibrillation presented with severe colicy abdominal pain. There was no guarding or rebound. CT scan was interpreted as showing superior mesenteric occlusion consistent with SMA embolus.
Superior mesenteric angiogram was performed which showed occlusion of the superior mesenteric with sparing of the proximal branches consistent with embolus. Superior mesenteric thrombosis usually begins at the origin of the vessel and occludes all branches. The acute angled takeoff of the superior mesenteric artery hemodynamically predisposes it to embolization. Atrial mural thrombus which forms during fibrillation most often breaks off and embolizes when the patient converts to sinus rhythm and the atrial kick affects the thrombus. Because of the patient's symptomatology she was taken to the operating room for embolectomy rather than using intra-arterial thrombolysis. The bowel looked dusky without clear demarcation after successful
embolectomy (see SMA embolus, VID 1025.) She was taken back to the operating room
on the first post-operative day for a planned second look. There was
demarcation of non-viable small bowel which was resected. Her
postoperative course was complicated by respiratory compromise and
renal failure, both of which were treated successfully.
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