Combined endovascular and surgical management of acute superior mesenteric artery embolism complicated by intestinal necrosis: a case report

Background Acute superior mesenteric artery embolism (ASMAE) is a clinically rare acute abdominal condition and a type of acute mesenteric ischemia. It is characterized by sudden onset, rapid progression, and a high rate of misdiagnosis. Due to atypical early symptoms (such as dissociation between abdominal pain and physical signs), diagnosis and treatment are often delayed. Currently, there is no highly specific biomarker available for definitive diagnosis. Treatment typically involves anticoagulation and vasospasmolysis, with interventional or surgical intervention selected based on the extent of intestinal wall necrosis. Case For a 42-year-old male patient with superior mesenteric artery embolism complicated by intestinal necrosis, continuous monitoring was carried out through interventional therapy, pharmacological support, and surgical treatment, along with abdominal CTA, arteriography, CT scans, and clinical examinations. Follow-up and timely re-examinations were conducted after discharge. Results The patient was successfully treated with a sequential therapeutic approach combining “interventional thrombectomy/thrombolysis” and “surgical bowel resection.” Interventional treatment partially recanalized the occluded vessel but failed to completely prevent intestinal necrosis. Timely surgical intervention removed 10 cm of necrotic small intestine, preventing further deterioration of the condition. Postoperative vascular imaging showed significant improvement in superior mesenteric artery blood flow. The patient eventually recovered and was discharged, with recent follow-up showing no discomfort. Conclusion The clinical manifestations and signs of this case of superior mesenteric artery embolism were atypical, and no abnormalities were found in D-dimer and lactate upon admission. However, when intestinal necrosis occurs, the early laboratory findings and signs become more typical. Through timely CT and CTA imaging assessments, dynamic monitoring of the condition, and multidisciplinary intervention, successful treatment was achieved, providing valuable insights for the diagnosis and management of similar cases.