A Case of Superior Mesenteric Artery Occlusion without causing Non-Cirrhotic Portal Hypertension

1. Case Summary
Non-cirrhotic portal hypertension is a potential consequence of superior mesenteric artery (SMA) occlusion. We reported the case of a 72-year-old female with an incidental finding of a critical SMA occlusion which did not result in non-cirrhotic portal hypertension due to the development of collaterals.
2. Case Details
A 72-year-old female was hospitalized following a sudden onset of left lower quadrant abdominal pain on a background of chronic constipation and overflow diarrhea.
During the admission, she had an abdominal CT, showing faecal loading and rectal distension with mild inflammatory stranding consistent with stercoral colitis. It promptly resolved after administering gastrograffin. Incidentally, an SMA occlusion was also found on CT.
The origin of the SMA demonstrates high-grade stenosis with post-stenotic dilatation of 6 mm and the formation of collaterals distally. There was no evidence of infarction. The SMA and collaterals can be visualized below [Figure 1].
An SMA occlusion can be acute, leading to acute mesenteric ischemia, or chronic, leading to non-cirrhotic portal hypertension. Non-cirrhotic portal hypertension commonly presents with esophageal varices, and less commonly ascites. However, there were no signs of either in our patient. Laboratory findings also show that the liver’s synthetic and excretory functions were normal.