Etiology and Early Treatment Results of Acute Mesenteric Ischemia

PURPOSE: Acute abdominal pain can be the result of many different pathophysiological processes. Among the many possible causes, acute mesenteric ischemia is a life threatening condition if the diagnosis is delayed. Generally, the mortality rate for other disease has gradually decreased; however, the mortality rate for acute mesenteric ischemia has not changed significantly and it continues to be 75% to 80% for acute mesenteric arterial embolism or thrombosis and 44% for acute mesenteric venous thrombosis. The aim of this study was to conduct an analysis of the clinical characteristics and mortality of the patients with acute mesenteric ischemia according to the etiology. METHOD: From 1989 to 2004, 43 patients were treated for acute mesenteric ischemia. Their mean age was 59 years, ranging from 24 to 81, and the male to female gender ratio was 24:19. We retrospectively analyzed their initial symptoms, the age and gender distribution, the treatment modalities and the mortality rates. RESULT: The causes of acute mesenteric ischemia were arterial embolism in 27 cases, arterial thrombosis including arterial dissection in 7 cases and venous thrombosis in 9 cases. Almost all of the patients complained of acute abdominal pain and abdominal tenderness. The overall mortality rate was 30.2% and the rates were 37.0% for mesenteric artery embolism, 42.9% for mesenteric artery thrombosis and 0% for mesenteric venous thrombosis. CONCLUSION: In this study, the causes of acute mesenteric ischemia were mesenteric artery embolism and thrombosis, including dissection and mesenteric venous thrombosis. The factors influencing the mortality were the cause of the acute mesenteric ischemia, the extent of involvement of the mesenteric vessels and the extent of bowel necrosis. Thus the most important things for the treatment of acute mesenteric ischemia are early diagnosis and proper treatment.

Iliac Arterio-Venous Fistula after Lumbar Discectomy

The vascular injuries that occur with lumbar discectomy are serious and often fatal complications. The incidence of such injuries is very low, but they are probably underestimated due to the various clinical manifestations such as retroperitoneal hemorrhage, hematoma and iliac artery-IVC vein fistula. A delayed diagnosis, and especially in case of iliac-IVC fistula, results in high output heart failure and cardiopulmonary insufficiency. We report here on 2 cases of iliac arteriovenous fistula that occurred after lumbar discectomy. An 18-year-old man and a 37-year-old man were admitted to our department with the symptoms of high output heart failure 3 and 24 days, respectively, after lumbar discectomy was performed. Both of them presented with clinical manifestations of pulmonary edema, tachycardia, hydrothorax and high output heart failure. One man died after an iliac artery stent graft and one man was salvaged after left common iliac vein ligation, aorto-common iliac artery bypass and left common iliac vein-IVC bypass surgery. Prompt diagnosis and aggressive treatment can hep to salvage the patients from these fatal complications. A high index of suspicion for this malady, based on the clinical signs, is mandatory.

An Isolated Femoral Artery Aneurysm Presenting with Leg Swelling

A femoral artery aneurysm (FAA) is a rare disease with the symptoms of nerve and vein compression, lower extremity ischemia, local pain, pulsating mass, and rupture. Compression of the femoral vein may cause the symptoms of lower extremity venous insufficiency, which accounts for nearly 10% of FAA patients. (Case) A 55 year-old female was hospitalized, suffering from swelling, heaviness and venous ectasia of the left lower extremity. Preoperative CT angiography revealed a 3 cm-sized FAA and compression of the femoral vein due to the aneurysm in her left inguinal area. The aneurysm extended from the distal external iliac artery (EIA) to both the proximal superficial femoral artery (SFA) and profunda femoris artery (PFA). After an aneurysmectomy, interposition grafting from the EIA to the SFA with reimplantation of PFA was done. Immediately after the operation, the symptoms dramatically disappeared, and the follow-up CT revealed the decompressed femoral vein.

Nonoperative Treatment for Grade IV Liver Injury / 한국간담췌외과학회지

PURPOSE: Though the nonoperative management of liver injury (NOMLI) has frequently been employed for traumatic liver injuries, the indications for NOMLI for grade IV liver injuries are still controversial. To determine the usefulness of the NOMLI in grade IV liver injuries, the clinical features of an operative management (n=26) and a NOMLI group (n=20) were compared. METHODS: For the 10 years up until Feb. 2004, 46 grade IV liver injury cases, according to the AAST liver injury scale, at the Kyung Pook National University Hospital, were selected for this study. The clinical features, grade of liver injury and outcomes of treatments were reviewed retrospectively. RESULTS: Of the 46 cases 40 (87%) and 6 (13%) were male and female, respectively. The mean ages of the male and female cases were 37.6 (15.2 and 34.5 (16.7 years, respectively. The causes of liver trauma were vehicle accident (71.7%, 33/46), industry accident (26.1%, 12/46) and violence (2.2%, 1/46). The accompanying abdominal injury was not present in the NOMLI group compared to 30.8% (8/26) in the operative management group. NOMLI was more than 2 times more frequently indicated after Feb. 1999. The mortality in operative management group was 11.5% (3/26) compared with none in the NOMLI group. 20% (4/20) of NOMLI group failed due to delayed bleeding and eventually had to undergo operations and the 80% (16/20) of NOMLI group was successful. The morbidity in successful NOMLI group was bile collection (6.25%, 1/16) and empyema (6.25%, 1/16). CONCLUSION: Nonoperative management for grade IV liver injury in hemodynamically stable patients without accompanying abdominal injury was successful. However, continuous monitoring and immediate operative management should be prepared for the delayed bleeding.