Acute Superior Mesenteric Artery Embolism Secondary to Left Ventricular Thrombus in a Young Male with Ischemic Cardiomyopathy: A Case Report

Authors

  • Nithya Shekar Department of General Surgery, Vydehi Institute of Medical Sciences & Research Centre, Bengaluru, Karnataka, India Author
  • Shwetha Y Department of General Surgery, Vydehi Institute of Medical Sciences & Research Centre, Bengaluru, Karnataka, India Author
  • Prithvi Shekar Department of General Surgery, Vydehi Institute of Medical Sciences & Research Centre, Bengaluru, Karnataka, India Author
  • Kalpana Vineet Department of General Surgery, Vydehi Institute of Medical Sciences & Research Centre, Bengaluru, Karnataka, India Author
  • Suhas L Department of General Surgery, Vydehi Institute of Medical Sciences & Research Centre, Bengaluru, Karnataka, India Author

Keywords:

Acute mesenteric ischemia; Superior mesenteric artery embolism; Left ventricular thrombus; Ischemic cardiomyopathy; Cardioembolism; Exploratory laparotomy.

Abstract

Introduction: Acute mesenteric ischemia (AMI) is a rare but life-threatening vascular emergency associated with high mortality due to delayed diagnosis and rapid progression to bowel infarction. Superior mesenteric artery (SMA) embolism secondary to left ventricular (LV) thrombus is an uncommon cause, particularly in young adults.

Aim & Objective: To highlight an uncommon case of AMI caused by SMA embolism secondary to LV thrombus in a young patient with ischemic cardiomyopathy and emphasize the importance of early diagnosis and prompt surgical intervention.

Case Presentation: A 31-year-old male with ischemic cardiomyopathy, previous anteroseptal myocardial infarction, severe LV systolic dysfunction (ejection fraction 35%), and documented LV thrombus presented with severe diffuse abdominal pain, distension, and obstipation for three days. Examination revealed generalized peritonitis. Investigations showed marked leukocytosis (22.46 × 10³/µL) with mildly elevated serum lactate (2.2 mmol/L). Echocardiography demonstrated a large LV thrombus measuring 4.5 × 0.9 cm. Contrast-enhanced CT revealed complete SMA occlusion, small bowel ischemia, chronic celiac trunk occlusion, and splenic infarction, suggesting systemic thromboembolism. Emergency laparotomy revealed approximately 30 cm of gangrenous jejunoileal bowel, which was resected with double-barrel stoma formation. Histopathology confirmed transmural ischemic necrosis with hemorrhagic congestion. Postoperatively, an enterocutaneous fistula developed and was managed conservatively with nutritional support and wound care.

Result: The patient recovered and was discharged in a hemodynamically stable condition on guideline-directed heart failure therapy and long-term anticoagulation.

Conclusion: LV thrombus is an uncommon but important cause of acute SMA embolism in young patients with ischemic cardiomyopathy. Mildly elevated serum lactate does not exclude advanced bowel ischemia. Early CTA, prompt surgical intervention, and multidisciplinary management are essential for improving outcomes in patients with acute mesenteric ischemia.

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Published

2026-08-29

Issue

Vol. 3 No. Issue 1 (2026)

Section

Articles

How to Cite

Acute Superior Mesenteric Artery Embolism Secondary to Left Ventricular Thrombus in a Young Male with Ischemic Cardiomyopathy: A Case Report. (2026). Journal of Surgical Research and Reviews (ISSN: 3041-4857) , 3(Issue 1), 1-7. https://internationalmedicalpublishing.com/index.php/JSRR/article/view/324