Avtor/Urednik		Rajković, Zoran; Zelić, Z.; Papeš, Dino; Čižmek, K.; Arslani, Nuhi
Naslov		Synchronous celiac axis and superior mesenteric artery embolism
Tip		članek
Vir		Vasa
Vol. in št.		Letnik 40, št. 6
Leto izdaje		2011
Obseg		str. 495-8
Jezik		eng
Abstrakt		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.
Deskriptorji		ABDOMINAL PAIN MESENTERIC ARTERY, SUPERIOR MESENTERIC VASCULAR OCCLUSION PORTAL VEIN BILIARY FISTULA CELIAC ARTERY EMBOLISM INTESTINE, SMALL LIVER SPLEEN STOMACH ATRIAL FIBRILLATION NECROSIS ISCHEMIA