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Ileal Hemorrhagic Infarction Due to Complete Obstruction of Superior Mesenteric Artery Associated with Mycotic Aneurysm, Report of an Autopsy Case H. Atari 1 , M. Igarashi 1 , M. Okudaira 1 , T. Katsumata 2 , H. Okabe 2 , S. Kusano 3 1Department of Pathology, School of Medicine, Kitasato University 2Department of Internal Medicine, School of Medicine, Kitasato University 3Department of Radiology, School of Medicine, Kitasato University pp.327-331
Published Date 1981/3/25
DOI https://doi.org/10.11477/mf.1403107988
  • Abstract
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 A 66 year-old housewife suffering from chronic renal failure was admitted to Kitasato Hospital on September 14, 1979, with a history for two days of tarry stools. On admission, physical examination revealed a pale edema of eyelids and cardiac enlargement with systolic murmur. Blood pressure was 118/72, pulse regular, and body temperature was 36.6℃. Pertinent positive physical finding were limited to intestinal hemorrhage. We could not find any cause of intestinal hemorrhage in spite of several endoscopical examination and intestinal barium enema. Intestinal hemorrhage continued.

 On the selective angiography, superior mesenteric artery showed complete obstruction at the base and the vasculature of small intestinal wall was altered and small in size and showed poor blood supply from inferior mesenteric branches and middle colic artery through dorsopancreatic arcade from truncus celiac. The patient became gradually drowsy and got worse because intestinal hemorrhage could not be controlled by conventional therapy.

 Blood pressure was not improved to normal level two weeks before death. Autopsy was performed three hours after death on November 14, 1979, because of massive intestinal hemorrhage and cardiac failure due to digital toxication. Generalized atherosclerosis was marked in the kidneys and abdominal aorta. Especially the orifice of the superior mesenteric artery showed complete obstruction macroscopically.

 Small intestinal wall was moderately thickened and anemic in almost the entire length. It was suggestive of chronic blood insufficiency like angina pectoris of the heart. The surface of the small intestinal mucosa was anemic with focal hemorrhage without edema. New, massive intestinal hemorrhagic necrosis was observed in segmental ileal region about 40 cm in length, beginning from 39 cm proximal from the ileocecal valve. The mesentery of this segment was also strikingly thickened and edematous with petechial hemorrhage and when sectioned, thrombi extruded from the cut ends of the ileal branch but no arterial ballooning. Pathological examination confirmed hemorrhagic infarction of the small bowel and thrombi of the mesenteric artery associated with mycotic aneurysm without rupture.

 We should notice mycotic aneurysm when a patient has a concomitant intestinal hemorrhage with severe renal failure and sepsis.


Copyright © 1981, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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