Rare direct embolism of urothelial carcinoma causing acute mesenteric ischaemia during remission

Metastatic abdominal carcinomas have been reported in the literature to cause bowel ischaemia. However, these are often associated with diffuse disease or direct invasion of adjacent bowel secondary to high-grade malignancies. There are no reported cases of extensive small bowel wall nor arterial occlusion as a result of metastasis from treated early-stage urothelial carcinoma. We present an octogenarian male patient who was diagnosed with small bowel ischaemia secondary to extensive metastatic urothelial carcinomatous to the small bowel. Thorough consideration of the patient’s clinical presentation and high index of suspicion was required to differentiate this from other causes of ischaemic bowel. The pathophysiology of the disease differentiated the end treatment most suitable for the patient.