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A D V E R T I S E M E N T
A D V E R T I S E M E N T
An 81-year-old man was hospitalized for treatment of congestive heart failure when he developed hypotension and acidosis followed by abdominal pain. The patient's antihypertensive meds had just been increased, and the patient had a history of atrial fibrillation and abdominal aortic aneurysm. Abdominal exam showed deep diffuse tenderness without guarding of rebound. CT scan was unremarkable, with no change in the aneurysm. A diagnosis of mesenteric ischemia was made, with the possibility of occlusive (embolus, thrombosis, aneurysm dissection) or low flow (medication induced hypotension, cardiogenic shock) etiologies. Angiography showed marked narrowing of the distal superior mesenteric branches, with minimal to absent capillary filling at the bowel wall.
A D V E R T I S E M E N T
In addition, on lateral view, there was significant stenosis of the origin of the celiac trunk. This narrowing combined with possible occlusion of the IMA due to the aneurysm (the IMA was not injected in order to minimize the dye load due to the patient's renal compromise), reduced the chances of collateral circulation (see lower GI bleed) contributing to the SMA territory.
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A D V E R T I S E M E N T
A bolus dose of papaverine was given through the catheter, and the catheter was left in place with a papaverine drip running. The patient's fluid balance and blood pressure were stabilized overnight and the patient's abdominal pain disappeared. Cardiac enzymes were negative for MI. The follow up SMA injection shown, demonstrated dilatation of the main SMA branches and capillary filling.
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This page was last modified on 7/27/2001.
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