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Thrombosis of the superior mesenteric artery
Last reviewed: 04.07.2025
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The most common cause of superior mesenteric artery thrombosis is widespread atherosclerosis.
The symptoms of superior mesenteric artery thrombosis are generally similar to those of embolism, but thrombosis differs in that abdominal pain is less intense and does not have a cramping nature. Mesenteric thrombosis may be latent for a certain time. However, as intestinal ischemia increases, the clinical symptoms also increase, intestinal infarction and peritonitis develop, and intestinal noises disappear.
Unlike the clinical picture of embolic occlusion of the superior mesenteric artery, early manifestations of thrombotic occlusion are insignificant: the pain syndrome is moderate and intermittent. With the development of intestinal infarction, the symptoms become similar to those observed with embolism of the superior mesenteric artery. It is noteworthy that the anamnesis of patients with thrombosis almost always contains indications of cardiovascular diseases with circulatory failure.
The diagnosis of mesenteric thrombosis is complicated by the fact that it is latent for a long time. Therefore, anamnestic data indicating intermittent claudication, abdominal pain after meals, as well as symptoms of cerebrovascular insufficiency should be given great importance. The above anamnestic information in combination with the results of a physical examination (palpation of the pulse in the peripheral arteries) allows us to identify signs of widespread atherosclerosis and suggest possible occlusion of the superior mesenteric artery. Particularly important is the significance of the detected combination of symptoms of widespread atherosclerosis with abdominal pain, which, according to JE Dunphy, can be a harbinger of fatal vascular occlusion.
Angiography is performed both for diagnostic purposes and to select a surgical approach.
In specialized institutions, treatment sometimes begins with thrombolytic therapy and dilation using a balloon catheter. However, these methods are only acceptable in the initial period of the disease and, in addition, are fraught with complications (bleeding, distal embolization). The only effective method is considered to be reconstructive surgery on the vessels for the purpose of revascularization and (if necessary) bowel resection.