Superior Mesenteric Arterial Embolism Associated with an Acute Limb Ischemia: A Case Report and Literature Review

Abdesslam Bouassria, Elbachir Benjelloun, Imane Kamaoui, Hicham Elbouhaddouti, Ouadii Mouaqit, Abdelmalek Ousadden, Khalid Mazaz, Khalid Ait Taleb, Laila Sedreddine, Mohammed El Abkari, SidiAdil Ibrahimi, Ihssane Mellouki

Department of Hepatology and Gastroenterology, School of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, University Hospital HASSAN II, Route de SidiHrazem, Morocco.
Department of Radiology, School of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, University Hospital HASSAN II, Route de SidiHrazem, Morocco.
Department of Surgery, School of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, University Hospital HASSAN II, Route de SidiHrazem, Morocco.

DOI: 10.4236/ojgas.2014.44027                

Abstract

Introduction: Acute mesenteric ischemia due to an embolism of the superior mesenteric artery (SMA) is associated with a high mortality rate. Over twenty per cent of acute mesenteric embolism cases consist of multiple emboli. Case Presentation: We present a rare case of a 62-year-old man admitted with acute abdominal pain and signs of intestinal occlusion related to an acute mesenteric ischemia due to superior mesenteric arterial embolism. It was associated with a synchronous acute bilateral lower limb ischemia due to embolic arterial occlusion. He underwent an emergency explorative laparotomy with proximal jejunal resection, and the patient made an excellent recovery. As for the acute limb ischemia, it was treated by efficient anticoagulation allowing limb salvage. Conclusion: When treating a superior mesenteric arterial embolism, the possibility of recurrent or multiple arterial thromboembolic events should be considered. A prompt diagnosis, aggressive surgical treatment and intensive care could improve the prognosis.

Keywords

SMA; Limb; Embolism; Ischemia

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Yamaguchi, T., et al. (1999) Local Thrombolytic Therapy for Superior Mesenteric Artery Embolism: Complications and Long-Term Clinical Follow-Up. Radiation Medicine, 17, 27-33.
[2]	Lock, G. (2001) Acute Intestinal Ischaemia. Best Practice & Research Clinical Gastroenterology, 15, 83-98. http://dx.doi.org/10.1053/bega.2000.0157
[3]	Bradbury, A.W., Brittenden, J., McBride, K. and Ruckley, C.V. (1995) Mesenteric Ischaemia: A Multidisciplinary Approach. British Journal of Surgery, 82, 1446-1459. http://dx.doi.org/10.1002/bjs.1800821105
[4]	Sitges-Serra, A., Mas, X., Roqueta, F., Figueras, J. and Sanz, F. (1988) Mesenteric Infarction: An Analysis of 83 Patients with Prognostic Studies in 44 Cases Undergoing a Massive Small-Bowel Resection. British Journal of Surgery, 75, 544-548. http://dx.doi.org/10.1002/bjs.1800750614
[5]	Mansour, M.A. (1999) Management of Acute Mesenteric Ischemia. Archives of Surgery, 134, 328-330. http://dx.doi.org/10.1001/archsurg.134.3.328
[6]	Haruna, et al. (2012) Acute Mesenteric Ischemia and Duodenal Ulcer Perforation: A Unique Double Pathology. BMC Surgery, 12, 21. http://dx.doi.org/10.1186/1471-2482-12-21
[7]	Yamada, et al. (2012) Upper Limb Amputation Due to a Brachial Arterial Embolism Associated with a Superior Mesenteric Arterial Embolism: A Case Report. BMC Research Notes, 5, 372. http://dx.doi.org/10.1186/1756-0500-5-372
[8]	Wooyul, P., Mi-Kyeong, O., Jee-Hun, K., Ha-Gyoung, K. and Sang-Sig, C. (2011) Paroxysmal Atrial Fibrillation Presenting as Acute Lower Limb Ischemia. Korean Journal of Family Medicine, 32, 423-427. http://dx.doi.org/10.4082/kjfm.2011.32.7.423
[9]	Walker, T.G. (2009) Acute Limb Ischemia. Techniques in Vascular and Interventional Radiology, 12, 117-129. http://dx.doi.org/10.1053/j.tvir.2009.08.005