Acute superior mesenteric artery thrombosis with small bowel gangrene: Managed by emergency revascularization and bowel resection

Abinesh. A1*, Deepa. S2, Subathra Devi. M3, Mahalakshmi4

1Critical Care Technician, ICU, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Assistant Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

3Nurse Educator, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

4Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Abstract

A 62-year aged woman, with a history of type 2 diabetes mellitus, hypertension, hypothyroidism, osteoarthritis and bronchial asthma, presented with fever, vomiting, and acute periumbilical abdominal pain. Contrast-enhanced CT abdomen revealed partial thrombus in proximal segment of SMA and complete thrombotic occlusion of its distal 2/3rd segment. The patient underwent emergency laparotomy with superior mesenteric artery (SMA) Fogarty thromboembolectomy and vein patch repair, followed by relaparotomy with small bowel resection and anastomosis With Anticoagulation, antibiotics, nutritional support and intensive postoperative care, the patient improved and was discharged to the ward.

Key words: Superior mesenteric artery (SMA); Osteoarthritis; Relaparotomy

Introduction

Acute superior mesenteric artery thrombosis is a life-threatening vascular emergency causing intestinal ischemia and bowel gangrene. Delayed diagnosis can rapidly lead to bowel necrosis, sepsis and death. Early diagnosis using contrast enhanced CT angiography and prompt surgical intervention are essential to improve survival. 

Case presentation

A case of a 62-year-old patient came with complaints of abdominal pain in the periumbilical region for the past 1day. H/O fever for 10 days, vomiting 3 episodes bilious and constipation flatus not passed

  • Social History: She does not have any social history of indulgence in tobacco and alcohol.
  • Allergies: No known medicine or environmental allergies
  • Past medical history: She has DM / SHT / Hypothyroidism / Osteoarthritis and Bronchial asthma, on regular treatment.
  • Past Surgical history: She has the past surgical history of Post Hysterectomy status
  • Physical examination: On arrival at our emergency room, she is conscious and oriented.

Vitals

PR92 b/min
BP120/70 mmHg
Temp 98°F
SpO299% in RA
RR20/min
GCSE4 V5 M6
CVSS1S2 (+)
RSBAE (+), bilateral NVBS (+)
P/ASoft
CNSNFND

Relevant Investigations

S.NoInvestigation NameResult
1Haemoglobin7.7 to 9.6 g/dl
2WBC18630 to 6690 cells/mm3
3Blood groupO Positive
4Sodium135 mmol/L to 129 mmol/L
5Potassium3.4 mmol/L to 3 mmol/L

CECT Abdomen report ; 07.07.26

  • Partial Thrombus in proximal segment of SMA and complete thrombotic occlusion of its distal 2/3rd segment
  • Common Hepatic Artery arising from SMA with extension of thrombus into it
  • Long segment circumferential hypodense wall thickening in jejunum with NO obvious Pneumatosis Intestinalis

CECT Abdomen report; 25.07.26

  • A large hyperdense intraperitoneal hematoma in the left side of peritoneal cavity with minima

CECT Abdomen report; 28.07.26

  • A large hyperdense intraperitoneal hematoma in the left side of peritoneal cavity with minimal mass effect with compression of displacement of adjacent bowel loops
  • Postoperative changes in the anterior abdomen with surgical staples in-situ
  • Minimal ascites
  • Minimal pleural effusion with posterior basal atelectasis bilateral lower lobes

 USG Abdomen: 24.07.26

  • A large heterogeneous lesion extending from left hypochondrium to periumbilical region as described? Hematoma

Echocardiogram; 08.07.26

  • Good LV systolic function
  • Grade 1Diastolic dysfunction
  • Trivial MR
  • EF60%

Diagnosis

Acute superior mesenteric artery (SMA) thrombosis segmental small bowel gangrene secondary to mesenteric ischemia .

Management

Name of the DrugDoseRouteFrequency
Inj. Meropenam1gmIVBD
Inj. Para1gmIVTDS
Inj. Metrogyl500 mgIVTDS
Inj. Heparin5000 UnitsIVQ6H
Tab. Aspirin75mgRTOD
Tab. Roseday20mgRTOD
Neb: Duolin+Budecort1 RespP/NTDS
Inj. Albumin correction
Inj. Potassium chloride correction
Inj. Human Actrapid correction

Surgical Management 07.07.2026

Emergency laparotomy+ SMA Fogarty thromboembolectomy + Vein patch repair done.

SMA :  Proximal 5cm:1cm thrombosis evacuated.  Distal 10cm:8cm thrombosis evacuated

Re-laparotomy + small bowel resection + anastomosis done on 10.07.2026

Nursing Management

She was admitted to the ICU following emergency exploratory laparotomy for superior mesenteric artery thrombosis small bowel gangrene. Nursing care was planned using a multidisciplinary, evidenced based approach with emphasis on hemodynamic stabilization, respiratory support, prevention of complication and promotion of recovery.

Comprehensive Assessment

  • Head to toe assessment was performed on admission and repeated regularly.
  • Monitored vital signs hourly.
  • Assessed level of consciousness hourly.
  • Monitor Pain and abdominal findings regularly.
  • Monitored intake output hourly.
  • Peripheral perfusion and ventilator parameters were closely monitored.
  • Laboratory investigation including CBC, ABG electrolytes, RFT and coagulation profile were reviewed to identify early clinical deterioration.

Mechanical ventilation and Airway management

  • Regularly checked ETT position and cuff pressure.
  • Monitored ventilator settings with intensivist.
  • Performed sterile suctioning, oral hygiene as per ICU protocol to prevent VAP.
  • Focused respiratory assessment, early recognition of respiratory fatigue, secretion management, and preparing for timely intervention.

Pain assessment and comfort measures

  • Assessed pain using validated tools (CPOT).
  • Administered prescribed analgesics and evaluated response
  • Provided 2nd hourly position, pressure relief, and supportive care.

Postoperative abdominal care

  • Inspected abdominal incision routinely for bleeding, infection, dehiscence, abnormal drainage.
  • Monitored surgical drains for amount
  • Assessed abdominal distension, bowel sounds, signs of peritonitis.

Infection prevention

  • Maintained strict aseptic techniques for all procedures and wound care
  • Maintained CVC line , urinary catheter and other invasive devices as per protocol.
  • Followed hand hygiene and standard precautions.
  • Monitor for fever, inflammatory markers, wound infection, catheter related infections, and sepsis.
  • Administered anticoagulants safely and monitored for bleeding.

Discussion

Acute SMA thrombosis is a vascular emergency requiring rapid diagnosis. CECT abdomen is the investigation of choice for early diagnosis. Early revascularization with Fogarty thrombectomy can salvage ischemic bowel. Delayed presentation may require bowel resection due to gangrene. Multidisciplinary management involving vascular surgery, gastrointestinal, intensive care, anticoagulation and nutritional support significantly improve patient outcomes.

Conclusion

Early recognition of acute mesenteric ischemic and prompt surgical revascularization, combined with intensive postoperative management are essential to reduce mortality and preserve bowel function in patients with superior mesenteric artery thrombosis. Critical care nursing played a  vital role in maintaining hemodynamic stability, optimizing respiratory functions, preventing post-operative complications, ensuring nutritional support, and co-ordinating multidisciplinary care. This case emphasizes that vigilant nursing assessment, evidence based interventions, and effective communications among healthcare professionals are essential to improve patient outcomes in acute mesenteric ischemia. Reporting such cases contributes to nursing knowledge and supports the development of best practices for managing critically ill patients with superior mesenteric artery thrombosis.

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