A 69-year-old man with untreated atrial fibrillation admitted for intermittent abdominal pain and bloody stool was found in computed tomography (CT) to have occlusion of the superior mesenteric artery (SMA). Laboratory data suggested intestinal necrosis necessitating emergency laparotomy. The jejunum and ileum were found to be ischemic but not necrotic. Intraoperative angiography showed the SMA to be occluded just distal to the first jejunal branch. Subsequent SMA exploration led to thrombectomy. The ischemic color of the small intestine recovered immediately after thrombectomy, as did pulsation of the blood supply to the small intestine. The postoperative clinical course of the patient was good. Our case demonstrates that intraoperative angiography is useful in evaluating the occlusion site in the SMA when the patient undergoes laparotomy with a diagnosis of intestinal necrosis and ischemic change is found to be reversible.
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