Successful clinical management of mesenteric ischemia caused by superior mesenteric artery obstruction and celiac artery stenosis: a case report

Acute mesenteric ischemia (AMI) is a rare, yet deadly thromboembolic accident that requires urgent surgery and or revascularization. We report the case of a 67-year-old male patient, who presented with severe abdominal pain and reduced oral intake, causing dehydration and impaired kidney function. The imaging evaluation including arterial Doppler and computed tomography (CT) scan showed AMI caused by superior mesenteric artery (SMA) obstruction and celiac artery stenosis, besides multiple atherosclerotic segments. Given the absence of guidelines in such an uncommon combination, a multidisciplinary management was initiated involving general medicine, general surgery, vascular surgery, and radiology. The agreed plan consisted of anticoagulation, exploratory laparotomy with necrosis resection and anastomosis, followed by percutaneous thrombectomy and angioplasty with stenting. The patient was discharged on day 7 postop with a highly satisfactory outcome and follow up. This case highlights the value of an early multidisciplinary approach in tailoring the management to the specific case of AMI.