RT Book, Section
A1 Wang, John C.
A1 Kashyap, Vikram S.
A2 Dean, Steven M.
A2 Satiani, Bhagwan
A2 Abraham, William T.
SR Print(0)
ID 1105290995
T1 ACUTE MESENTERIC ISCHEMIA
T2 Color Atlas and Synopsis of Vascular Diseases
YR 2015
FD 2015
PB McGraw-Hill Medical
PP New York, NY
SN 9780071749541
LK accesssurgery.mhmedical.com/content.aspx?aid=1105290995
RD 2024/04/16
AB A  74-year-old  hypertensive  male  presents  with  a  four-hour  history  of  acute-onset  severe  diffuse  abdominal  pain.  Two  weeks  prior  he  was  hospitalized  with  a  large  anterior  wall  MI  complicated  by  intermittent  atrial  fibrillation.  Due  to  a  history  of  frequent  falls,  he  was  not  anticoagulated.  Physical  examination  is  remarkable  for  an  uncomfortable  individual  with  an  irregularly  irregular  heart  rhythm  and  a  minimally  tender  abdomen  without  peritoneal  signs.  Laboratory  assessment  is  remarkable  for  a  leukocytosis  of  14,000  and  mild  metabolic  acidosis.  Electrocardiography  indicates  atrial  fibrillation  with  a  rapid  ventricular  response  between  120  and  140  beats/minute.  CT  scan  of  the  abdomen  illustrates  a  distended  small  bowel  and  a  questionable  filling  defect  within  the  superior  mesenteric  artery  (SMA).  Mesenteric  arteriography  displays  a  "mercury  meniscus  sign"  within  the  SMA  4  cm  from  the  aorta.  A  diagnosis  of  cardioembolic  acute  mesenteric  ischemia  is  made  and  the  patient  is  immediately  taken  to  the  operating  suite.