Acute Intestinal Ischemia Due to Thrombosis of the Superior Mesenteric Artery in a Female Young Patient: A Clinical Case

Introduction: Acute mesenteric ischemia is deadly from 50% to 90% of cases due to poor understanding of the clinical picture of abdominal pain and the differential diagnosis when it is not suspected and partly because of an unacceptable delay in making the diagnosis. Clinical case: A 31-year-old female with generalized abdominal pain without peritoneal irritation accompanied by vomiting and loose bowel movements. Vital signs: BP 90/70 mmHg, HR 100/min, BF 20/min, Temperature 96.8°F. Laboratory test: Bh: Hto. 39.4, 42.6/103 leukocytes/uL, 89% neutrophils, 10% lymphocytes; QS: glucose 226 mg/dL. It is surgically intervenes finding intestinal ischemia to 10 cm from the ligament of Treitz to 1 m from the ileocecal valve, the root of the mesentery is explored and superior mesenteric artery is explored obtain feeling weak pulse. Thrombectomy is performed with infusion of 1000 IU of heparin in saline solution return to viability of ischemic bowel loops in 50% viable resulting 50 cm from the ligament of Treitz to 2 m from the ileocecal valve; in nonviable bowel segment resection is performed. Discussion: The clinical diagnosis of mesenteric ischemia is difficult, and in most cases the abdominal pain is the cardinal symptom. The basis of the proper treatment of this entity is: early diagnosis, resection of the damaged intestine, restoration surgical blood flows or nonsurgical, second-look laparotomy and support of the ICU, as handled case described here.