Ramona Matusevičiūtė1, Dominykas Kaupas1, Rytis Stasys Kaupas2
1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania
2Lithuanian University of Health Sciences Kaunas Clinics, Radiology Clinic, Department of Interventional Radiology, Kaunas, Lithuania
Abstract
Background. Acute mesenteric ischemia (AMI) is the cause of acute abdomen in up to 10% of patients over 70 years of age. Acute occlusion of the superior mesenteric artery (SMA) is the most common cause of AMI, which can be caused by both thrombotic changes due to arterial atherosclerosis and embolism. A typical clinical triad of acute embolic SMA occlusion is severe abdominal pain disproportionate to clinical signs, vomiting and / or diarrhoea and an obvious source of embolism. Triphasic computed tomography angiography is the first-line diagnostic method for this pathology. According to European guidelines endovascular treatment should be the primary treatment in most cases.
Case report. In this case report we analysed a 28-year-old patient who is significantly younger than the majority of AMI patients and was using intramuscular testosterone injections. Systemic embolism from left ventricle emboli was observed and acute coronary ischemia syndrome appeared to the patient. The patient was diagnosed with dilated cardiomyopathy due to a mutation in the titin (TTN) gene.
Conclusions. When treating patients with acute abdomen symptoms young age should not be a reason to rule out the suspicion of acute mesenteric ischemia. Moreover, if an atypical case of this pathology is diagnosed, further examination of the patient is required to determine the exact cause.
Key words: acute mesenteric ischemia, superior mesenteric artery, percutaneous aspiration thrombectomy, endovascular treatment, dilated cardiomyopathy, testosterone