The Diagnosis And Treatment Of Acute Superior Mesenteric Artery Embolism

Objective:To investigate the clinical features, early diagnosis and surgical therapy of acute superior mesenteric artery embolism (ASMAE).Methods:A retrospective analysis was performed in12patients with acute superior mesenteric artery embolism (ASMAE) who underwent surgical treatment between January2011and December2013in the second affiliated hospital of medical school,zhejiang university, analyzing their clinical feature,diagnosis,treatment and prognosis.Result:There were12patients(7males and5females).The mean age of the patients was54.2±10.6years (range35-69years). All of the patients had accompanying heart diseases, including10(7males and3females) with auricular fibrillation and4(1male and3females) with mitral valve lesions such as mitral valve stenosis or insufficiency. All12patients had not taken any anticoagulant and antiplatelet agents for at least three month before disease onset. Patients were referred to hospital due to abdominal pain. Organic heart disease were discovered in7of the12patients in the first place. The mean time between start of the abdominal pain and first visit was9.33±3.98hours (range4-8hours).8cases in all of12patients detected by X-Ray were indicated with incomplete intestinal obstruction,1with obvious signs of intestinal obstruction,4with suspicious ASMAE by color Doppler ultrasonography. All the patients were examined with abdominal computed tomography. All of the12patients underwent abdominal artery embolectomies and parial small intestinal resections.None of the patients had infective complication after surgery. Two cases appeared with short bowel syndrome due to the excision of intestine and received long-term nutrition support therapy. All patients received long-term oral warfarin more than6months to control INR2-3in order to prevent recurrence of embolism. Six months follow-up showed no other complications occurred.Conclusion:ASMAE is a critical surgical disease. The selective superior mesentery angiography is the golden standard for the SAME diagnosis. And the abdominal vascular CTA can be as the first choice in diagnosing SAME. The preferred treatment strategy of ASMAE is surgical treatment。When diagnosis is clear, especially for intestinal necrosis, if no operation it will be a serious threat to the patient’s life. Although there are different levels of cardiovascular disease, patients should also be surgical treatment.Consequently,the key of improving prognosis and improving patient’s survival are early detection and early surgery.