Superior mesenteric embolus accompanied by renal infarction associated with atrial fibrillation successfully treated by anticoagulants: A CARE-compliant case report

INTRODUCTION: Occlusive arterial acute mesenteric ischemia resulting from either thrombosis or embolism is a major cause of superior mesenteric ischemia, which is an emergency condition associated with a high rate of mortality. This report aimed at discussing the applicability of anticoagulants alone as a conservative treatment strategy for patients with superior mesenteric artery (SMA) embolism. PATIENT CONCERNS: A 70-year-old woman with a history of hypertension and dyslipidemia presented to our emergency department with persistent moderate-to-severe lower abdominal dull pain for three hours. Her vital signs and initial laboratory studies were normal. DIAGNOSIS: An enhanced abdominal computed tomographic scan revealed a filling defect in the SMA and an infarcted right kidney suggestive of a diagnosis of SMA embolism. An electrocardiogram showed atrial fibrillation. Subsequent blood sampling demonstrated an elevated D-dimer level at 6.08 mg/L. INTERVENTIONS: Surgery was not indicated due to the absence of bowel necrosis or overt peritonitis. The patient was admitted to the cardiology ward, where anticoagulation therapy with a 5-day course of subcutaneous enoxaparin was started, followed by switching to oral edoxaban. OUTCOMES: The patient was discharged uneventfully 1 week after admission. CONCLUSION: Our unexpected discovery of a case of SMA embolism complicated with right renal infarction underscored the need for vigilance in identifying the condition through imaging studies, pinpointing the potential contributor (e.g., atrial fibrillation), and implementing appropriate treatment. Our case underscores the importance of anticoagulation once the diagnosis is made and the efficacy of conservative treatment in selected patients without signs of systemic inflammation or peritonitis.