Twelve Cases of Superior Mesenteric Artery Embolism at Our Hospital / 日本農村医学会雑誌

We examined 12 cases of superior mesenteric artery (SMA) embolism experienced at our hospital from January 2012 to February 2022. All patients had a history of atrial fibrillation. In 5 cases, surgery was not performed due to poor general condition. Intestinal resection was performed in 4 of the 7 patients who underwent surgery. Four patients who did not undergo intestinal resection had their clot removed within the golden time of around 10 h since the onset of abdominal pain, while 3 patients who underwent intestinal resection had their clot removed after more than 10 h since onset. Patients who underwent intestinal resection had a longer hospital stay than those who did not (130.5 vs. 32.6 days). All of the patients who underwent surgery were discharged alive. On the other hand, all patients who did not undergo surgery died before discharge. There was no significant difference in age or time between onset and diagnosis in relation to the indication for surgery. SMA embolism is a less common disease occurring in about 1% of cases of acute abdominal disease, but the mortality rate is high at about 50% and the prognosis is poor. Based on our findings, it is important to distinguish SMA embolism for patients with sudden abdominal pain and to diagnose it early after onset and remove the clot to resume blood flow within the golden time when intestinal preservation can be expected. For patients in a stable general condition, treatment such as open or laparoscopic thrombectomy and intestinal resection should be considered regardless of age or time since onset of the disease.

Clinical Experience of Enteral Feeding Catheter Placement via the Diaphragm During Esophagectomy and Gastric Tube Reconstruction via the Posterior Mediastinal Route / 日本農村医学会雑誌

Simultaneous creation of an enterostomy for enteral nutrition during esophagectomy has been useful in our experience, but bowel obstruction associated with intestinal fistula remains a problem. Therefore, in this study, we retrospectively reviewed 18 patients with esophageal cancer who underwent transdiaphragmatic transgastric tube enteral feeding catheter placement during gastric tube reconstruction via the mediastinal route after esophagectomy from November 2012 to March 2014. The catheter was guided from the gastric tube into the gastrointestinal tract, with the tip placed in the jejunum distal to the ligament of Treitz. From the gastric tube, the catheter was guided along the diaphragm to the anterior abdominal wall through the extraperitoneal route. No bowel obstruction associated with catheter placement has been observed in any of the patients from the time of surgery to this writing. Also, the procedure enabled jejunostomy use for more than 5 years, similar to conventional jejunostomy. We experienced 1 case of catheter deviation into the mediastinum. Overall, transgastric tube enteral feeding catheter placement for reconstruction of the posterior mediastinal gastric tube was useful for avoiding intestinal obstruction associated with jejunostomy. However, there may be a risk of catheter displacement into the mediastinum.