An Emergent Operation Case of Acute Thrombotic Superior Mesenteric Ischemia Occurred After Initiation of Anticoagulant Therapy for a Left Atrial Thrombus Nobuhiro Takeuchi 1 , Yoshiharu Nishibori 1 , Takao Maruyama 1 , Tetsuo Horimatsu 1 , Shigeki Masuda 1 , Koichi Fujita 1 , Masanori Takata 1 , Sayuri Tanaka 2 , Satoko Kubo 2 , Akihito Otsuka 2 , Takeo Kimoto 3 1Department of Internal Medicine, Division of Cardiology, Kawasaki Hospital in Kobe 2Department of Internal Medicine, Kawasaki Hospital in Kobe 3Department of Surgery, Kawasaki Hospital in Kobe Keyword: 左房内血栓 , 抗凝固療法 , 急性腸管虚血症 , left atrial thrombus , anticoagulant therapy , acute mesenteric ischemia pp.329-335
Published Date 2012/3/15
DOI https://doi.org/10.11477/mf.1404101918
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 An 82-year-old woman complained of chest pain during her hospitalization for urinary tract infection. Transthoracic echocardiography showed an immobile thrombus of 28.1×13.8mm in the left atrium. Six days after admission,transient cerebral ischemic attack occurred, so anticoagulant therapy for the left atrial thrombus was initiated. Sixteen days after admission, she had upper abdominal pain. Contrast-enhanced CT at the level of the pelvis showed small bowel obstruction with poorly-enhanced bowel wall and total occlusion of the ileal artery. The patient was diagnosed as having acute thrombotic superior mesenteric ischemia. An emergent operation was performed and about 240 cm of gangrenous small bowel was resected. In this case, the occlusion of the mesenteric artery might have been caused by a mobile and floating thrombus originating in the left atrium after initiation of anticoagulant therapy.

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