CT scan show acute mesenteric ischemia secondary to occluded SMA from an embolic source (arrow). Image shows- A- Celiac aery B- Left kidney C- Superior mesenteric aery D- Right kidney This elderly woman complains of sudden-onset severe abdominal pain in the epigastric region that is inconsistent with the physical findings. She has a history of widespread atherosclerotic vascular disease affecting the coronary aeries and peripheral vasculature. The presence of blood in the stool suggests bowel injury, and the low level of serum bicarbonate is consistent with a metabolic acidemia. Bowel ischemia or necrosis is causative. Aerial occlusion may occur from rupture of the atherosclerotic plaque or embolization from another clot. This patient's mid abdominal symptoms suggest aeriography of the SMA, and the celiac aery might be diagnostic. On confirmation, surgical embolectomy is usually helpful. The moality rate is high in such patients. Although the first pa of the duodenum is supplied by the superior pancreaticoduodenal aery, which receives its blood from the celiac aery, the remainder of the small intestines is supplied by branches of the SMA.