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Open Access Highly Accessed Case Report

Upper limb amputation due to a brachial arterial embolism associated with a superior mesenteric arterial embolism: a case report

Tsuyoshi Yamada12, Toshitaka Yoshii1*, Hideya Yoshimura3, Koji Suzuki4 and Atsushi Okawa12

Author Affiliations

1 Section of Orthopedic and Spinal Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

2 Global Center of Excellence (GCOE) Program for International Research Center for Molecular Science in Tooth and Bone Disease, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

3 Section of Orthopedic Surgery, Kawaguchi Industrial General Hospital, 1-18-15 Aoki, Kawaguchi-shi, Saitama, 332-0031, Japan

4 Section of Orthopedic Surgery, Toride Kyodo Hospital, 2-1-1, Hongou, Toride-shi, Ibaraki, 302-0022, Japan

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BMC Research Notes 2012, 5:372  doi:10.1186/1756-0500-5-372

Published: 24 July 2012

Abstract

Background

Acute mesenteric ischemia due to an embolism of the superior mesenteric artery is associated with a high mortality rate. Over 20 percent of acute mesenteric embolism cases consist of multiple emboli, and the long-term prognosis depends on the incidence of subsequent embolic events at other sites. The incidence of emboli in the upper extremity associated with a superior mesenteric arterial embolism has rarely been described. The signs and symptoms of ischemic change in the upper limb can be masked by other circumstances, such as postoperative conditions or complications. In these cases, a late presentation or delayed diagnosis and treatment can result in limb loss.

Case presentation

We present a rare case of a 67-year-old Japanese woman with atrial fibrillation who developed an embolic occlusion of the brachial artery associated with a superior mesenteric arterial embolism. She developed gangrene in her right hand, which had progressed to the point that amputation was necessary by the time the gastrointestinal surgeon had consulted the Department of Orthopedic Surgery. The brachial arterial embolism diagnosis was delayed by the severe abdominal symptoms and shock conditions that followed the emergency enterectomy, resulting in amputation of the upper limb despite anticoagulation therapy. In this case, multiple infarctions of the spleen were also observed, indicating a shower embolism.

Conclusions

When treating a superior mesenteric arterial embolism in a patient with atrial fibrillation, the possibility of recurrent or multiple arterial thromboembolic events should be considered, even after the procedure is completed.

Keywords:
SMA; Embolism; Upper limb; Amputation