PMC6319509_01
Abdominal plain radiography showing free air (a, triangle). Enhanced abdominal computed tomography showing severe calcification of the origin of the SMA (arrow), bubble-like intramural gas of the small bowel (circle), and pneumoperitoneum (triangle) (b, c)
42155_2018_25_Fig1_HTML.jpg
PMC6319509_01_42155_2018_25_Fig1_HTML.jpg
Fig1
Abdominal plain radiography showed free air between the liver and diaphragm, and PI (Fig. 1a). Abdominal computed tomography showed severe calcification of the SMA origin; SMA peripheral flow was reserved (Fig. 1b). Computed tomography (CT) revealed bubble-like intramural gas of the small bowel with the contrasted wall pneumoperitoneum (Fig. 1c).
Angiography revealed the anatomical variations of the SMA replacing the common hepatic artery (a), and severe stenosis of the origin of the SMA with calcification (arrow) (b)
42155_2018_25_Fig2_HTML.jpg
PMC6319509_01_42155_2018_25_Fig2_HTML.jpg
Fig2
The findings showed severe stenosis of the SMA origin with calcification, and the SMA had replaced the common hepatic artery (Fig. 2a, b).
Stenting to the SMA and the common hepatic artery with the kissing stent technique was performed (a). The final angiography showed satisfactory circulation to the SMA and the common hepatic artery (b)
42155_2018_25_Fig3_HTML.jpg
PMC6319509_01_42155_2018_25_Fig3_HTML.jpg
Fig3
After dilation, two balloon-expandable stents (5-mm PALMAZ Genesis (Cardian Health, Ohio, USA) to the SMA and 6-mm PALMAZ Genesis to the common hepatic artery) were implanted with the kissing stent technique from the common ostium (Fig. 3a). Final angiography showed satisfactory circulation to the terminal organ from the orifice (Fig. 3b).