A case of acute superior mesenteric embolism successfully treated by embolectomy

Superior mesenteric artery embolism is undoubtedly fatal unless operative intervention is promptly performed. The first case successfully managed by embolectomy in Taiwan is reported in this communication. The key to successful management lies in the early suspicion in patients with atrial fibrillation or recent myocardial infarction, presenting with sudden abdominal pain and an unremarkable physical examination. Abdominal angiography is strongly recommended; however, immediate laparatomy should not be postponed if angiography is not available. Early embolectomy is the only useful means of treatment to restore mesenteric circulation, preserve the bowel and rescue the patient. A 56-year-old woman was admitted with a 5-year history of rheumatic heart disease and atrial fibrillation. She had a sudden attack of severe abdominal pain 8 hours after cardiac catheterization. Abdominal examination was not remarkable and plain abdominal X-ray was negative, while bloody stools and leukocytosis developed 7 hours later. Superior mesenteric embolism was highly suspected and emergency laparotomy was performed. Successful embolectomy was carried out through the distal approach and the patient recovered completely without requiring small bowel resection. All branches of the superior mesenteric artery were demonstrated patent upon postoperative angiography.