Clinical Implications for the Management of Acute Thromboembolic Occlusion of the Superior Mesenteric Artery

Acosta, Stefan; Ögren, Magnus; Sternby, Nils H.; Bergqvist, David; Björck, Martin

doi:10.1097/01.sla.0000154269.52294.57

Cited by 150 publications

(113 citation statements)

References 17 publications

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“…In a review of Herbert et al, it is reported that only one third of the patients was diagnosed as AMI before the surgical exploration and death (5). In Swedish autopsy studies, it was shown that real mortality rate from mesenteric ischemia can be more than 90 %, and 22-32 % of these patients could be diagnosed before death (8,9). It is known that delays at establishing the AMI diagnosis reduce the survival chance and morbidity (4).…”

Section: Introductionmentioning

confidence: 99%

The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

Aydın¹,

Ozban²,

Serinken³

et al. 2015

BLL

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INTRODUCTION: Acute mesenteric ischemia (AMI) is an abdominal-vascular emergency which is rare and has high mortality rates (60-80 %) due to late diagnosis (1-3). Although it is known that extravascular reasons like intestinal intussusception, volvulus, strangulated hernias and obstructions can cause intestinal gangrene, these are rarely the cause of AMI (1). MATERIALS AND METHODS: In this study, we used male Wistar-Albino rats weighing 250-300 grams obtained from Pamukkale University Experimental Research Laboratory. Animals were exposed to light-dark cycles for 12 hours and had free access to food and water. They were kept in cages for 7 days to stabilise their intestinal fl ora. In animals of group I, nothing was made other than taking 0.5 ml blood intracardially. In other animals, abdomen was reached with midline laparotomy and superior mesenteric artery (SMA) was located. In group II (operative control group), SMA was isolated and manipulated but was not ligated. In Group III (intestinal ischemia group), SMAwas isolated and ligated with 3/0 silk tie distally to the aorta. After this process, intestinal ischemia was achieved which was confi rmed by paleness and pulselessness of intestines, caecum and right colon. Later on, abdomen was closed with double 3/0 polyglactin sutures. At postoperative 1st, 4th and 6th hours 0.5 ml blood was taken intracardially from the animals in groups II and III in order to quantify D-dimer and L-lactate levels. LABORATORY TESTS: D-dimer: Blood samples which were put into tubes containing sodium citrate, were seperated from plasma with centrifugation at 4000 rpm for 7 minutes. L-lactate: Blood L-lactate levels were determined from blood taken into capillary tubes with the help of immobilised enzyme electrode technology using YSI 1500 Sport portative lactate analyzer (Yellow Springs Instruments Inc., Ohio-USA). HISTOPATHOLOGIC VERIFICATION: Two cm long intestinal samples were taken from animals in which SMA was ligated in order to achieve mesenteric ischemia and these samples were fi xed in 10 % formol. DISCUSSION: As a result, in rats with SMA occlusion serum D-dimer levels were not increased signifi cantly when compared either in the group or with the basal values of the control group and values in operative control group. Therefore, it is concluded that D-dimer is not a useful marker for early diagnosis of AMI. On the other hand, it is revealed that blood L-lactate levels began to increase signifi cantly following 4th hour of mesenteric ischemia and it is shown that this increase continued at the 6th hour. In addition, considering the utmost importance of the early diagnosis in patients with the clinical suspicion of AMI, L-lactate seems to be a suitable marker to use in emergency departments because it is achieved with a portable device that gives fast and accurate results. Nevertheless, our results are need to be supported by clinical studies with larger patient series (Tab. 2, Fig. 11, Ref. 39). Text in PDF www.elis.sk.

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Section: Introductionmentioning

confidence: 99%

The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

Aydın¹,

Ozban²,

Serinken³

et al. 2015

BLL

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“…83 cases (39%) revealed synchronous emboli in other arteries, renal artery emboli were 50(23%), common hepatic artery was 12(5%), iliac artery was 27(12%) and splenic artery was 28(13%). And they also reported that 93(43%) cases have old brain infarction [2]. Infarctions in multiple major organs simultaneously occurred with acute mesenteric ischemia.…”

Section: Discussionmentioning

confidence: 98%

“…Acute mesenteric artery ischemia is relatively rare acute abdominal vascular event caused by aging, atrial fibrillation, aortic atheroma and infectious endocarditis [1,2]. The incidence is 5.3 per 100,000 inhabitants yearly, and its mortality is 60% to 80% [3].…”

Section: Introductionmentioning

confidence: 99%

Acute Mesenteric Ischemia after Recurrent Embolic Stroke

Oguro¹,

Yamaguchi²

2015

Int J Gastroenterol Disord Ther

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We report the case of a 76-year-old woman with acute mesenteric artery ischemia and atrial fibrillation after recurrent embolic strokes. She had sudden severe abdominal pain and vomiting, and was admitted to the hospital in coma and shock state. Accompanied with metabolic acidosis and multiple organic failures, she died at 13 hours after the onset. Pathological examination revealed that acute thrombotic occlusion of superior mesenteric artery, splenic artery and right celiac artery. The occluded arteries pathologically showed progressive arteriosclerotic change and secondary multiple thrombi. This case demonstrated that atrial fibrillation with recurrent embolic stroke could cause mesenteric artery ischemia, progressive thrombi of abdominal viscera and sudden death. Acute Mesenteric Ischemia after Recurrent Embolic Stroke Keywords:Acute mesenteric ischemia, Recurrent embolic stroke, Case ReportOpen Access IntroductionAcute mesenteric artery ischemia is relatively rare acute abdominal vascular event caused by aging, atrial fibrillation, aortic atheroma and infectious endocarditis [1, 2]. The incidence is 5.3 per 100,000 inhabitants yearly, and its mortality is 60% to 80% [3]. It counts 0.4 % in patients with acute abdominal pain. Acute mesenteric ischemia is a life-threatening emergency that requires early diagnosis, intervention to restore mesenteric blood flow and resection of the necrotic bowel tissues by surgical treatments [4]. This report describes a patient with atrial fibrillation and recurrent stroke which rarely cause acute mesenteric ischemia and sudden death with multiple organic failures and lower limb ischemia. After stroke onset sudden abdominal pain and followed by shock state is suggestive of diagnosis of acute mesenteric ischemia. Case ReportA 77-year-old Japanese woman with atrial fibrillation and hypercardiomyopathy was treated by a cardiologist. Two months earlier she had embolic strokes of the right middle cerebral artery, then oral anticoagulation by warfarin had been administered to prevent recurrent stroke. In spite of controlling anticoagulant therapy by warfarin within two months, the prothrombin time-international normalized ratio(PT-INR) with 10 times analysis, three of ten times apparently showed inadequate values below the therapeutic range (0.93, 1.00 and 1.33). The CT scan of the head showed hemorrhagic infarction caused by recanalization after occlusion of the right middle cerebral artery (Figure 1). The echocardiography showed left atrial spontaneous echo contrast on previous stroke onset. On the 66 th day after the stroke onset, she experienced severe nausea, vomiting and abdominal pain in the morning, and delivered to our hospital. On arrival at our emergency department, she was coma. Her blood pressure could not be measured, and heart rater pulse was 124 bpm with irregular rhythm. Respiratory rate was 42/min and her temperature was 34.2 degrees. Right lower limb showed pale color and hemorrhagic purpura with pulseless iliac artery. Her abdomen showed rebound tenderne...

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“…The severity of injury depends on etiology of ischemia, systemic blood pressure, collateral circulation flow, response of mesenteric vessels to autonomic stimulators, amounts of circulatory autonomic stimulators, regional hormonal factors, presence of cellular metabolites after reperfusion of the ischemic bowel, and duration of ischemia 2,7,11,12,17,23,24,25,26 Four pathologic factors have been described as the cause of acute mesenteric ischemia including: superior or inferior mesenteric artery emboli, thrombosis of these vessels, venous thrombosis, and non occlusive mesenteric ischemia 5,9,12,21 Emboli is the most common cause of AMI 1,14,15,25 Appropriate diagnosis of this disease depends on a high clinical suspicion particularly in elderly an patient who has history of cardiovascular disease 14,7,21,22 Early diagnosis and early intervention to ameliorate vascular obstruction are critical in patient's salvage 1,4,9,22,27 . Appropriate resuscitation of the patient and diagnostic studies and early surgical or non surgical intervention is the most effective approach to save the patient 1,3,9,28 .…”

Section: Introductionmentioning

confidence: 99%

Mesenteric Ischemia: Results Of Surgical Treatment And A Review Of Literature

Mozaffar¹,

Kharazm²,

Far³

et al. 2007

IJS

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Background: Acute Mesenteric Ischemia (AMI) is one of the causes of acute abdomen which occurs because of significant decrement in bowel perfusion. Mortality rates of 60 to 100 percent have been reported in different studies in relation to this fatal disease (1, 5, ,11, 16,18,28). In this study, we review clinical features, laboratory findings, abdominal x rays, ECGs, intraoperative findings and results of treatment in 32 patients who were admitted in Shohada-E-Tajrish hospital with final diagnosis of AMI from March 1996 to March 2002. Methods: 32 patients with final diagnosis of AMI who were admitted in Shohada-E-Tajrish hospital were included in this retrospective study by means of review of their files and medical records. Results: The disease was more common in men than women, with a 2:1 male: female ratio. The mean age of patients was 60 years. Abdominal pain was the most common symptom of patients followed by nausea, vomiting, obstipation, hematemesis, and melena. On physical exam tachycardia was prevalent. Oliguria was seen in approximately 70% of patients and it was related to mortality. 10% of patients were in shock status related to mortality. 30% of patients had peritoneal signs, but it was not related to mortality. In laboratory tests, leukocytosis was present in 95% of patients, and in 50% of cases it was more than 20000/mm³. Acidosis was seen in 80% of patients and overall mortality rate was 75%. Conclusion:The final advice of the study is to pay intensive attention to resuscitation of the patients, correction of metabolic and homodynamic derangements, and performing laparotomy as soon as these derangements were corrected. In some patients it is necessary to perform second look operation to evaluation of the viability of the intestine.

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Clinical Implications for the Management of Acute Thromboembolic Occlusion of the Superior Mesenteric Artery

Cited by 150 publications

References 17 publications

The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

Acute Mesenteric Ischemia after Recurrent Embolic Stroke

Mesenteric Ischemia: Results Of Surgical Treatment And A Review Of Literature

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