Successful treatment in superior mesenteric artery embolism: a case report and literature review (original) (raw)
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Open Journal of Gastroenterology, 2014
Introduction: Acute mesenteric ischemia due to an embolism of the superior mesenteric artery (SMA) is associated with a high mortality rate. Over twenty per cent of acute mesenteric embolism cases consist of multiple emboli. Case Presentation: We present a rare case of a 62-year-old man admitted with acute abdominal pain and signs of intestinal occlusion related to an acute mesenteric ischemia due to superior mesenteric arterial embolism. It was associated with a synchronous acute bilateral lower limb ischemia due to embolic arterial occlusion. He underwent an emergency explorative laparotomy with proximal jejunal resection, and the patient made an excellent recovery. As for the acute limb ischemia, it was treated by efficient anticoagulation allowing limb salvage. Conclusion: When treating a superior mesenteric arterial embolism, the possibility of recurrent or multiple arterial thromboembolic events should be considered. A prompt diagnosis, aggressive surgical treatment and intensive care could improve the prognosis.
European Journal of Vascular and Endovascular Surgery, 2004
Objective. To determine the incidence of acute thrombo-embolic occlusion of the superior mesenteric artery (AOSMA) in a population-based study. Material. All clinical (n ¼ 23,446) and forensic (n ¼ 7569) autopsies performed in the city of Malmö between 1970 and 1982 (population 264,000 -230,000 inhabitants). The autopsy rate was 87%. Methods. Calculation of the incidence of AOSMA with intestinal gangrene in those autopsies coded for bowel ischaemia (997/23,446 clinical and 9/7569 forensic autopsies). The operative procedures performed in 1970, 1976 and 1982 were also analysed. Results. Two forensic and 211 clinical autopsies demonstrated AOSMA with intestinal gangrene. Previous suspicion of intestinal ischaemia was noted in only 33%. Sixteen patients were operated. The cause-specific mortality was 6.0/1000 deaths. The incidence was 8.6/100,000 person years, increasing exponentially with age (p , 0.001). Mortality was 93%. Conclusions. The incidence and mortality of AOSMA is higher than previously reported from clinical series. There is seldom any suspicion of the diagnosis prior to death.
Korean journal of radiology
To evaluate the technical feasibility and clinical outcome of percutaneous aspiration embolectomy for embolic occlusion of the superior mesenteric artery (SMA). Between January 2010 and December 2013, 9 patients with embolic occlusion of the SMA were treated by percutaneous aspiration embolectomy in 2 academic teaching hospitals. The aspiration embolectomy procedure was performed with the 6-Fr and 7-Fr guiding catheter. Thrombolysis was performed with urokinase using a multiple-sidehole infusion catheter. The clinical outcome was investigated retrospectively. Superior mesenteric artery occlusion was initially diagnosed by computed tomography (CT) in all patients, and all patients had no obvious evidence of bowel infarction on CT scan. Percutaneous aspiration embolectomy was primarily performed in 6 patients, and thrombolysis was initially performed in 3 patients. In 3 patients who received primary thrombolysis, percutaneous aspiration was undertaken because the emboli were resistant...
Surgical Therapy for Acute Superior Mesenteric Artery Embolism
The American Journal of …, 2004
Background: Acute mesenteric artery embolism has a high rate of morbidity and mortality. Early diagnosis and appropriate treatment are the most important factors associated with morbidity and mortality. Methods: During the period between 1997 and 2002, 24 patients underwent superior mesenteric artery embolectomy. The patients were divided into three groups according to the onset of symptoms and operation time. Group I (n ϭ 12) patients were operated on in the first 6 hours after onset of symptoms; group II (n ϭ 9) patients were operated on between 6 and 12 hours after onset; and group III (n ϭ 3) patients underwent embolectomy after 12 hours. Low-dose (5 to 10 mg) local tissue-type plasminogen activator (t-PA) administration directly into the superior mesenteric artery was an additional procedure with the embolectomy in all patients. Results: The macroscopic view of the intestine was normal in 15 patients (12 patients in group I and 3 patients in group II) 30 minutes after the administration of local t-PA. Segmental resection was necessary in 4 patients in group II. Extended resection was necessary in 2 patients in group II and 3 patients in group III, and all of the patients died during the early postoperative period. Conclusions: We suggest that explorative laparotomy should be done in patients with sudden abdominal pain, nausea, vomiting, mild leukocytosis, and metabolic acidosis who have previous valvular heart disease or atrial fibrillation. Ultimately, selective low dose t-PA (5 to 10 mg) administration reduces the length of intestinal portion to be resected.
Mezenterik damarların spontan olarak rüptürü çocuklarda çok nadir bir durumdur. Bu çalışmada travma öyküsü olmaksızın akut karın ve hemorajik şok tablosu ile başvuran 14 yaşında ikiz eşi bir erkek çocuk sunulmaktadır. Acil laparotomide a. mezenterika superiorun rüptüre olduğu saptanmış, onarımı denendiyse de ileri derecede vasküler frajilite nedeni ile başarılamamıştır. Tüm orta barsakta nekroz geliştiğinden, duodenumdan inen kolona kadar geniş rezeksiyon yapılması gerekmiş, duodenal ve kolonik uçlar kapatılmıştır. Ameliyat sonrasında abdominal kompartman sendromu, duodenal fistül ve sepsis gelişen hastada üç hafta içerisinde hem kompartman sendromu, hem de fistül kaybolmuştur. İkiz eşinde ve hastamızdaki atipik yüz görünümü, ince cilt yapısı, kanamaya eğilim bulgularının eşliğinde, yapılan histopatolojik incelemenin de desteği ile ameliyattan 4 hafta sonra Ehler Danlos Sendromu Tip IV tanısı konulabilmiştir. Ameliyat sonrası 3. ayda spontan gelişen femoral arteriovenöz fistül konservatif tedavi edilebilmiş, ancak, hasta ince barsak nakli için bekleme listesinde iken beş ay sonra kaybedilmiştir. Abdominal apopleksi olgularında Ehler Danlos Sendromu akılda tutulmalıdır. Bu olgulardaki vasküler komplikasyonların onarımı tip III kollajen anormalliğine bağlı vasküler frajilite nedeni ile mümkün olmayabilir.
Cardiovascular and interventional radiology, 2015
Retrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA). From 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised. We achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %. Primary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended al...
A study of 25 patients on surgical management of acute mesenteric vascular thrombosis
International Journal of Surgery Science, 2021
To study outcome of surgical management of acute mesenteric vascular thrombosis like Extent of disease Extent of resection Post-operative survival Patients and Methods: This study of 25 cases of diagnosed with acute mesenteric vascular thrombosis (MVT) from September 2016 to October 2018 in department of surgery, civil hospital Ahmadabad. Inclusion criteria: Patients with acute abdominal pain who is diagnosed as MVT in either on CT-scan or on exploration. Exclusion criteria: Patient with non-occlusive mesenteric ischemia that did not require laparotomy. Patient with only portal vein thrombosis. Results: Among 25 patients, 23 patients underwent exploratory laparotomy. Two patients were expired before surgery. In present study, maximum number of patients is in the age group 41-50 years. In 23 patients exploratory laparotomy was done based on their clinical feature with peritoneal signs with CECTabdomen pelvis finding. Mortality rate was 64% in my study while 9 (36%) patients are in follow-up, so early diagnosis and decision of intervention has saved 36% of patients. Conclusion: Mesenteric vascular thrombosis is one of the most lethal vascular disorders. So, this type of moribund conditions require urgent use of abdominal CT-Scan and increasing use of anti-coagulative medication improved the outcome in patients. This disease entity is lethal prompt decisions should be taken for patients survival.
Superior Mesenteric Artery Occlusion: A Case Report
SBV Journal of Basic, Clinical and Applied Health Science
Background: Acute mesenteric ischemia (AMI) is a dreaded surgical condition, that still remains a reason for concern despite advances in laboratory investigations and imaging modalities, because of its nonspecific clinical presentation. Case description: In this case report, we describe a 57-year-old gentleman who presented with acute abdomen and septic shock 24 hours following symptom onset. Emergency exploratory laparotomy was done and the patient was found to have extensive bowel gangrene of superior mesenteric artery (SMA) territory. Conclusion: Patients with abdominal pain out of proportion to clinical signs, vomiting, and diarrhea should arouse a clinical suspicion of mesenteric ischemia. Early diagnosis is the most imperative to the successful management of AMI.
Superior Mesenteric Artery Syndrome: Diagnosis and Management
PubMed, 2017
Superior mesenteric artery syndrome is a life-threatening rare acquired upper gastrointestinal disorder due to mechanical compression of third part of duodenum by the acute angulation of Superior mesenteric artery, leading to obstruction. Acute loss of intervening mesenteric fat as a result of a variety of debilitating conditions is believed to be the etiologic factor causing the reduced aortomesenteric angle. Abdominal CT angiography showed the dilatation of second part of duodenum and vascular compression of the proximal third part of the duodenum between the aorta and superior mesenteric artery. We report a case of 15 year old young boy who presented with recurrent postprandial pain in the epigastric region, accompanied by epigastric fullness, nausea, postprandial bilious vomiting and weight loss. When conservative measures were ineffective, laparoscopic retrocolic duodenojejunostomy, side to side anastomosis, was performed in the patient to relieve the obstruction. This case report is unusual as it is concerned with the description of a rare disease entity and its radiological appearances for early preoperative diagnosis, better understanding and management of the disease are discussed in the pertinent light of literature.