A 52-year-old man had the abrupt onset of severe abdominal pain and vomiting during hospitalization in our hospital for the treatment of atrial fibrillation. Enhanced CT scan showed a low-enhanced area in the main trunk of the superior mesenteric artery (SMA), and acute mesenteric artery occlusion was diagnosed. Thrombolytic therapy with intra-arterial infusion was employed for the patient, because surgery entailed a great risk due to his underlying disease of uncontrollable congestive heart failure, and about three hours had elapsed from the onset of the symptoms. Angiography visualized incomplete occlusion at 6cm distal to the bifurcation of SMA. Intra-arterial infusion therapy with 960, 000IU of urokinase and 20μg of prostaglandin E₁ was started 4.5 hours after the onset of the symptoms. Most of the thrombus was lysed by the infusion therapy, but the infusion therapy was sustained for further 48 hours because of a partially remnant thrombus and persisting slight abdominal pain. Thereafter these symptoms subsided and the patient was discharged from the hospital on the 7^th day after the infusion therapy.
We present this case of acute SMA occlusion in which conservative thrombolytic therapy was successfully conducted bymaking early diagnosis.