Fig. 3.

A 61-year-old male patient presenting with early acute mesenteric ischemia. The contrast-enhanced CT (portal venous phase) showed a decreased enhancement of the proximal jejunum (a) and ileum (b) wall. Digital subtraction angiography showed complete occlusion of the superior mesenteric artery (SMA) (c). Partial revascularization of the proximal jejunum arteries was achieved after 12 h of in situ thrombolysis with no opacification of the distal SMA (white oval) (d). Unfortunately, the patient experienced further clinical deterioration. Contrast-enhanced CT showed thickening of the jejunum wall with fat stranding (arrow) consistent with reperfusion injury following the recanalization of the jejunal arteries (e). Peri-hepatic fluid (arrowhead) was also noted. Additionally, CT showed a dilated jejunum with a persistent absence of wall enhancement, suggesting transmural necrosis of non-revascularized segments (f). The patient underwent a laparotomy that confirmed the absence of necrosis of the jejunum. He underwent subsequent resection of 225 cm of the small bowel and suffered from short bowel syndrome