DOI: 10.36347/sjmcr.2017.v05i06.015

Pages: 406-407

An 87-year-old man had undergone a medical examination and was prescribed medicine to treat epigastralgia at a facility near our hospital one day before his arrival at our hospital. When his son checked on him the next day, he was unconscious. He was in a state of coma with shock and was therefore transported to our hospital by ambulance. Whole body computed tomography, which was performed to detect the focus of unstable circulation, revealed both pleural effusion (right dominant), ascites, small bowel distention with fluid level, intraluminal gas (pneumatosis cystoides intestinalis), and showed that the diameter of the superior mesenteric vein (SMV) was smaller than that of the superior mesenteric artery (SMA) (the smaller SMV sign), suggesting SMA ischemia and intestinal necrosis. As he had severe multiple organ failure due to septic shock, the surgeon decided not to perform surgical resection. The smaller SMV sign suggests intestinal hypo-perfusion and a decrease in blood flow in the SMA. For diagnosing acute superior mesenteric artery ischemia, the detection of smaller SMV on plain CT is useful for patients with severe condition.