Document Detail

Synchronous celiac axis and superior mesenteric artery embolism.
MedLine Citation:
PMID:  22090184     Owner:  NLM     Status:  MEDLINE    
We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patient,s condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.
Z Rajkovic; Z Zelic; D Papes; K Cizmek; N Arslani
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  VASA. Zeitschrift für Gefässkrankheiten     Volume:  40     ISSN:  0301-1526     ISO Abbreviation:  VASA     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-17     Completed Date:  2012-01-31     Revised Date:  2012-10-19    
Medline Journal Info:
Nlm Unique ID:  0317051     Medline TA:  Vasa     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  495-8     Citation Subset:  IM    
Zabok General Hospital, Zabok, Croatia.
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MeSH Terms
Abdominal Pain / etiology
Atrial Fibrillation / etiology
Biliary Fistula / radiography
Celiac Artery / radiography*
Embolism / radiography*
Fatal Outcome
Gallstones / complications,  radiography
Intestinal Fistula / radiography
Intestine, Small / blood supply,  pathology
Ischemia / radiography*
Liver / blood supply,  pathology
Mesenteric Artery, Superior / radiography*
Mesenteric Vascular Occlusion / radiography*
Portal Vein / radiography
Spleen / blood supply,  pathology
Stomach / blood supply,  pathology
Tomography, X-Ray Computed*

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