Multidisciplinary diagnostic and therapeutic approach to acute mesenteric ischaemia: A case report with literature review

Superior mesenteric artery embolisation is the most common cause of acute mesenteric ischaemia. Superior mesenteric artery embolisation can be caused by various cardiac diseases (myocardial ischaemia or infarction, atrial tachyarrhythmias, endocarditis, cardiomyopathies, ventricular aneurysms and valvular disorders), arterial aneurysms, ulcerated atherosclerotic plaques of the major arteries and others. A case of 65-year-old, previously healthy man with superior mesenteric artery embolism, who was found to also have mural aortic thrombi, is presented. The patient underwent an emergency procedure; small intestine and cecum were resected and jejuno-ascendo anastomosis was performed. The patient was put on lifelong anticoagulation therapy. Neither cardiac diseases nor arterial aneurysms were detected. There were no signs of underlying atherosclerosis. Work-up for antiphospholipid antibodies and rheumatic diseases was negative. Tumour markers were within normal levels and blood cultures were negative. This case represents the challenges in recognising an underlying cause of acute mesenteric embolism and highlights the importance of multidisciplinary diagnostic and treatment approach.

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Acute mesenteric ischaemia, a highly lethal disease with a devastating outcome

VASA ◽

10.1024/0301-1526.35.2.106 ◽

2006 ◽

Vol 35 (2) ◽

pp. 106-111 ◽

Cited By ~ 19

Author(s):

Safioleas ◽

Moulakakis ◽

Papavassiliou ◽

Kontzoglou ◽

Kostakis

Keyword(s):

Mortality Rate ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Bowel Resection ◽

Morbidity Rate ◽

Time Interval ◽

Mesenteric Ischaemia ◽

Acute Mesenteric Ischaemia ◽

Artery Embolism ◽

Significant Difference

Background: Acute mesenteric ischaemia remains a serious condition requiring emergency surgical management. The mortality rate still remains high, due to the unspecific and delayed diagnosis and ranges from 59% to 100%. Purpose of our study is to present our experience in the management of the disease. Patients and methods: This is a retrospective study of 61 patients treated surgically for acute mesenteric ischaemia, between 1988 and 2004. All patients underwent a laparotomy. 75% of the patients were operated within the first 24 hours and the rest within 48 hours. Results: Superior mesenteric artery embolism occurred in 36 (59%), thrombosis in 21 (34%) and superior mesenteric vein thrombosis in 4 (7%) cases. In 49 (80%) cases, embolectomy or thrombectomy of the superior mesenteric artery with resection of the necrotic segment of the bowel was performed. Twelve cases (20%) were considered inoperable because of massive bowel necrosis. According to our study mortality and morbidity rate amounts to 75% and 80% respectively. No significant difference in the mortality rate between patients with embolism (75%) and thrombosis (76%) was found. However a significant increase of mortality rate was observed when the surgical intervention became afterwards the first 24-hour period. (72% versus 87%). Patients who underwent embolectomy or thrombectomy with bowel resection presented an improved survival rate compared with patients that underwent only bowel resection. (p = 0.019) Conclusions: Acute mesenteric ischaemia has the characteristics of a highly lethal condition and only early recognition and appropriate treatment can reduce the potential for a devastating outcome. The reduction of time interval from the beginning of symptoms up to the treatment remains the main critical important factor.

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Occlusion of the celiac trunk, the inferior mesenteric artery and stenosis of the superior mesenteric artery in peripheral thrombangiitis obliterans

VASA ◽

10.1024/0301-1526.38.4.394 ◽

2009 ◽

Vol 38 (4) ◽

pp. 394-396 ◽

Cited By ~ 3

Author(s):

Çakmak ◽

Gyedu ◽

Akyol ◽

İ. Kepenekçi ◽

Köksoy

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Celiac Trunk ◽

Occlusive Disease ◽

Mesenteric Ischaemia ◽

Buerger’S Disease ◽

Buerger's Disease ◽

Acute Mesenteric Ischaemia ◽

Thrombangiitis Obliterans

Buerger‘s disease is an inflammatory occlusive disease which commonly involves medium-sized or smaller vessels of extremities. Mesenteric involvement in Buerger‘s disease is very rare. It can occur at any time during the course of the disease and presents with acute mesenteric ischaemia. In this study, a case of Buerger‘s disease with mesenteric involvement diagnosed before the onset of acute mesenteric ischaemia and managed endovascularly is reported.

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Endovascular Treatment for Acute Mesenteric Ischaemia in a Young Woman with Polyarterial Disease

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.261.ish ◽

2017 ◽

Vol 26 (1) ◽

pp. 81-84

Author(s):

Mihai C. Ober ◽

Călin Homorodean ◽

Dan A. Tătaru ◽

Antonia E. Macarie ◽

Camelia D. Ober ◽

...

Keyword(s):

Myocardial Infarction ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Bowel Perforation ◽

Computed Tomographic Angiography ◽

Mesenteric Ischaemia ◽

Acute Mesenteric Ischaemia ◽

Computed Tomographic ◽

Coeliac Trunk ◽

Tomographic Angiography

Background: Acute mesenteric ischaemia is a condition with a grim prognosis on conservative treatment. Endovascular revascularisation is a promising approach for some of these patients.Case report: We present the case of a 44-year-old woman with a history of severe arterial hypertension, left leg claudication, and overlooked symptoms of chronic mesenteric ischaemia for one year, who was admitted for severe abdominal pain for one week. Computed tomographic angiography (CTA) showed acute mesenteric ischaemia by occlusion of the coeliac trunk and the superior mesenteric artery (SMA), without bowel perforation. In addition, CTA showed tight left renal stenosis and left external iliac stenosis. We performed angioplasty with a stent of the SMA, followed by revascularisation of the left renal artery. On control injection, the SMA appeared re-occluded, requiring a second stent implantation and a loading dose of dual antiplatelet therapy, with a good final result. Subsequently, the clinical course was uneventful, with no need of surgical exploration; a second procedure was planned, aiming at iliac revascularisation. At one month, the patient was asymptomatic, with normal Doppler flow in the SMA. Angiographic control during iliac revascularisation procedure showed a permeable SMA with a good filling of the coeliac trunk territory. Because of the suspicion of fibro-muscular dysplasia as aetiology, coronary angiography and cerebral CTA were performed, in order to exclude other potential lesions.Conclusions: Endovascular revascularisation in AMI is a promising alternative to the surgical approach in patients presenting without bowel perforation. Nevertheless, its safety and many tactical details remain to be clarified. Existing networks for revascularisation in acute myocardial infarction may be useful for the implementation of this approach.Abbreviations: AMI: Acute Mesenteric Ischaemia; CTA: Computed Tomographic Angiography; ICU: Intensive Care Unit; SMA: Superior Mesenteric Artery; STEMI: ST-segment Elevation Myocardial Infarction.

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Angioplasty and stenting of the superior mesenteric artery in acute mesenteric ischaemia

Australasian Radiology ◽

10.1111/j.0004-8461.2004.01334.x ◽

2004 ◽

Vol 48 (3) ◽

pp. 426-429 ◽

Cited By ~ 10

Author(s):

RP Lim ◽

RJ Dowling ◽

KR Thomson

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mesenteric Ischaemia ◽

Acute Mesenteric Ischaemia ◽

Angioplasty And Stenting

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Synchronous celiac axis and superior mesenteric artery embolism

VASA ◽

10.1024/0301-1526/a000154 ◽

2011 ◽

Vol 40 (6) ◽

pp. 495-498 ◽

Cited By ~ 1

Author(s):

Rajkovic ◽

Zelic ◽

Papes ◽

Cizmek ◽

Arslani

Keyword(s):

Atrial Fibrillation ◽

Small Intestine ◽

Abdominal Pain ◽

Ct Scan ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Abdominal Cavity ◽

Celiac Axis ◽

Contrast Administration ◽

Artery Embolism

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patients condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.

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