A Rare Case Report of Delayed Diagnosis of Superior Mesenteric Artery (SMA) Thrombosis Leading to Extensive Bowel Resection

TL;DR

A 60-year-old man with SMA thrombosis required emergency surgery after delayed diagnosis caused severe bowel damage.

Contribution

This case report highlights the rare and severe clinical course of SMA thrombosis leading to extensive bowel resection.

Findings

CECT revealed SMA thrombosis with liver and spleen infarcts and bowel necrosis.

Emergency surgery confirmed gangrene in multiple bowel segments requiring resection.

Histopathology confirmed transmural gangrene and mesenteric thrombi.

Abstract

A 60-year-old male presented with sudden-onset right-sided abdominal pain radiating to the back, along with vomiting and constipation for four days. Clinical examination revealed a distended and diffusely tender abdomen with absent bowel sounds. Contrast-enhanced computed tomography (CECT) of the abdomen showed near-complete thrombotic occlusion of the proximal superior mesenteric artery with distal reformation, infarcts in the liver and spleen, and features suggestive of small bowel necrosis and perforation. An emergency laparotomy revealed gangrene involving the distal jejunum, ileum, cecum, appendix, ascending colon, and part of the transverse colon. The patient underwent right hemicolectomy with resection of the distal jejunum and ileum, followed by distal jejunostomy and transverse colostomy. Histopathology confirmed transmural gangrene and thrombi in mesenteric vessels. This case describes the clinical presentation, radiological findings, surgical management, and histopathological features in a patient with extensive bowel involvement due to superior mesenteric artery thrombosis.

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