Clinical analysis of 66 cases of acute superior mesenteric artery embolism confirmed by surgery and angiography / 中华消化杂志

Objective To explore the clinical manifestation,treatment and prognosis of patients with acute superior mesenteric artery embolism (ASMAE).Methods From October 2012 to March 2018,the clinical data of 66 patients with ASMAE who were admitted to The First Affiliated Hospital of Chongqing Medical University were collected and retrospectively analyzed.The patients were divided into the death group and the survival group according to whether they died during hospitalization.The clinical features,the time of diagnosis and treatment methods of two groups were compared.T-test and chi-square test were performed for statistical analysis.Results Among 66 ASMAE patients,16 were in the death group and 50 in the survival group.The age of the death group was (75.6 ± 9.9) years,which was greater than that of the survival group ((68.1 ±13.2) years),and the difference was statistically significant (t =1.998,P =0.041).Among 16 dead patients,the case numbers of diagnosis time less than six hours,complicated with atrial fibrillation,peritoneal irritation sign,weakened or disappeared bowel sounds and complicated with systemic inflammatory response syndrome were 0,14,9,9 and 16,respectively.However,among 50 survival patients,the case numbers of diagnosis time less than six hours,complicated with atrial fibrillation,peritoneal irritation sign,weakened or disappeared bowel sounds and complicated with systemic inflammatory response syndrome were 15 (30.0％),30 (60.0％),14 (28.0％),14 (28.0％) and 36 (72.0％),respectively.The differences between two groups were all statistically significant (x2 =4.621,4.125,4.261,4.261 and 4.134,all P ＜ 0.05).Conclusions When sudden severe abdominal pain occurs in elderly patients with atrial fibrillation,ASMAE should be alerted.Early (less than six hours) and correct diagnosis can improve the prognosis of the ASMAE patients.

Treatment of superior mesenteric artery embolism by percutaneous mechanical thrombectomy with the SolitaireAB stent system / 实用放射学杂志

Objective To evaluate the curative effect and security of mechanical thrombectomy with SolitaireAB stent system in acute superior mesenteric artery embolism(SMAE).Methods The clinical data of 5 cases who had undergone mechanical thrombectomy with SolitaireAB stent system under digital subtraction angiography (DSA) were analyzed retrospectively.Results A successful thrombus removal of superior mesenteric arterial by SolitaireAB stent system was observed in the whole 5 patients.The patients had recovered well after operation and no complications such as arterial dissection,perforation and hemorrhage or intestinal ischemia occurred.Conclusion The arterial mechanical thrombectomy with SolitaireAB stent system are characterized with high rate of recanalization,fine security,minimal invasion and less complications in patients with acute superior mesenteric arterial embolism.

Surgical Treatment for Prosthetic Infective Endocarditis Complicated by Superior Mesenteric Artery Embolism / 日本心臓血管外科学会雑誌

<p>A 75-year-old man, who had undergone aortic valve and ascending aorta replacement at the age of 73 years, was admitted to our hospital with one week of fever. Blood culture showed growth of <i>Streptococcus bovis </i>and echocardiography showed vegetation on the prosthetic valve. Although antibiotic treatment was commenced, he complained of abdominal pain, and computed tomography showed a superior mesenteric artery embolism. The abdominal pain improved with fasting, but echocardiography showed another vegetation, and re-aortic valve replacement was performed to prevent embolism recurrence. When he resumed eating postoperatively, he again complained of abdominal pain and computed tomography showed mesenteric ischemia. The necrotic intestine was extensively resected and he recovered successfully. A superior mesenteric artery should be revascularized to 2/11 prevent perioperative mesenteric ischemia when cardiac surgery complicated by acute superior mesenteric artery embolism is performed.</p>

Creatine kinase and computed tomography angiography to evaluate short-term prognosis of patients with superior mesenteric artery embolism / 中华消化外科杂志

Objective To investigate the value of creatine kinase and computed tomography(CT)angiography to evaluate short-term prognosis of patients with superior mesenteric artery embolism(SMAE).Methods The retrospective cross-sectional study was adopted.The clinical data of 26 patients with SMAE who were admitted to the first Affiliated Hospital of Wenzhou Medical University between January 2008 and October 2015 were collected.The patients received serologic examination and CT angiography firstly,and then medicinal conservative method and surgical method were respectively conducted according to the results of above examinations.Observation indices:(1)clinical features,(2)serum indicators results,(3)CT angiography results:①location(main stem and non-main stem)of SMAE and development of distal branches of superior mesenteric artery(SMA),②indirect signs,such as bowel wall thickening,bowel dilatation combined with effusion and air accumulation and pneumatosis intestinalis,(4)therapy and prognosis.Measurement data with normal distribution were presented as-x±s,comparisons among groups were analyzed by one-way ANOVA.Measurement data with skewed distribution were presented as M(range)and analyzed by the Kruskal-Wallis rank sum test,and pairwise comparison was done using the Nemenyi test.Results(1)Clinical features:of 26 patients with SMAE,6 patients had intestinal ischemia,8 patients had partial intestinal necrosis and 12 patients had long segmental intestinal necrosis(postoperative short bowel syndrome in 5 patients and total small intestinal necrosis and partial colonic necrosis in 7 patients).Duration of symptoms before diagnosis was(1.7±0.8)days in 6 patients with intestinal ischemia and(2.1±1.1)days in 8 patients with partial intestinal necrosis and(1.5±0.7)days in 12 patients with long segmental intestinal necrosis,with no statistically significant difference(F=1.27,P＞0.05).(2)Serum indicators results:levels of serum creatine kinase in patients with intestinal ischemia,partial intestinal necrosis and long segmental intestinal necrosis were 68 U/L(range,50-86 U/L),98 U/L(range,54-244 U/L)and 300 U/L(range,40-873 U/L),respectively,with a statistically significant difference among patients(H=7.32,P＜0.05)and between patients with intestinal ischemia and with long segmental intestinal necrosis(H=7.21,P＜0.05),and with no statistically significant difference between patients with partial intestinal necrosis and with intestinal ischemia or long segmental intestinal necrosis(H=1.53,2.07,P＞0.05).(3)CT angiography results:①developments of SMAE(main stem and non-main stem)and distal branches of SMA:main stem embolism of SMA in 13 patients demonstrated hypodense shadow,with non-contrast of distal branches of artery,including 1 with intestinal ischemia,1 with partial intestinal necrosis and 11 with long segmental intestinal necrosis.Main stem embolism of SMA in 8 patients demonstrated hypodense shadow,with contrast of distal branches of SMA,including 3 with intestinal ischemia,4 with partial intestinal necrosis and 1 with long segmental intestinal necrosis.Main stem embolism of SMA in 2 patients demonstrated hypodense shadow,with non-contrast of distal branches of SMA,showing partial intestinal necrosis.Non-main stem embolism of SMA in 3 patients demonstrated hypodense shadow,with contrast of distal branches of SMA,including 2 with intestinal ischemia and 1 with partial intestinal necrosis.②Indirect signs:5 patients had bowel wall thickening,including 3 with intestinal ischemia and 2 with long segmental intestinal necrosis.Seventeen patients had bowel dilatation combined with effusion and air accumulation,with gas fluid level in local intestinal canal,including 2 with intestinal ischemia,5 with partial intestinal necrosis and 10 with long segmental intestinal necrosis.Two patients had pneumatosis intestinalis,with bubble shadow of bowel wall,showing long segmental intestinal necrosis.(4)Therapy and prognosis:of 6 patients with intestinal ischemia,1 underwent embolectomy of SMA and 5 underwent low-molecular-weight heparin anticoagulation and vasodilator alprostadil therapy.Eight patients with partial intestinal necrosis received resection of necrotic intestine.Of 12 patients with long segmental intestinal necrosis,5 with postoperative short bowel syndrome received resection of necrotic intestine combined with postoperative parenteral hyperalimentation.The above-mentioned patients were improved and discharged from hospital after symptomatic treatment and surgery.Twelve patients with long segmental intestinal necrosis,7 with total small bowel necrosis and partial colonic necrosis underwent only exploratory laparotomy and then were dead in a short time.Conclusion Elevated creatine kinase and main stem embolism of SMA combined with non-contrast of distal branches using CT angiography maybe predict poor short-term prognosis of patients with SMAE.

Left atrial ball thrombus with acute mesenteric ischemia: Anesthetic management and role of transesophageal echocardiography.

A 62 year old female with severe mitral stenosis, large left atrial ball thrombus and acute mesenteric ischemia emergently underwent mitral valve replacement, left atrial clot removal and emergency laparotomy for mesenteric ischemia. Peri‑operative management issues, particularly, the anesthetic challenges and the role of transesophageal echocardiography are discussed.

Successful aspiration and thrombolytic therapy for acute superior mesenteric artery occlusion / 대한외과학회지

To report a case of acute superior mesenteric artery (SMA) embolism successfully treated with aspiration and pharmacological thrombolysis. A 74-year-old female was admitted to the hospital with acute abdominal pain 5 hours in duration. Computed tomography angiography revealed a complete embolic occlusion distal to the first jejunal branch of the SMA. Aspiration and local continuous thrombolysis with urokinase resulted in near complete revascularization of the mesenteric flow after 4 hours and almost complete restoration after 20 hours. The patient made a complete recovery and continues to do well on warfarin therapy after treatment. Aspiration and thrombolytic therapy can be an alternative treatment modality in surgical high risk patient.

DIAGNOSIS AND TREATMENT OF ACUTE SUPERIOR MESENTERIC ARTERY EMBOLIZATION / 解放军医学杂志

Acute superior mesenteric artery embolism(MAE) is uncommon in clinical, but is a severe surgical abdomen. Owing to its unfamiliarity, clinicians often made misdiagnosis. This report summarized the experience in diagnosis and surgical therapy of 25 cases of acute superior mesenteric artery embolism. The results suggested that patients with a history of heart and peripheral arterial obstructive disease encountering severe abdominal pain and hemorrhage of digestive tract, which could not be relieved by narcotics, should be considered as early signs of acute superior mesenteric artery embolism. Twenty-three were operated out of the 25 cases, among tham, 5 cases were subjected to resection of partial small intestine after removal of the embolus, 18 cases received bowel resection. In the 23 cases of MAE, 10 were cured and 13 died, the mortality in perioperative period was 57%. Early diagnosis and prompt treatment are the key to improve the therapeutic effects of AME.