Surgery Book

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Superior Mesenteric Artery Occlusion

Aka: Superior Mesenteric Artery Occlusion, Acute Superior Mesenteric Artery Occlusion, Superior Mesenteric Artery Embolism, Superior Mesenteric Artery Thrombosis, Mesenteric Artery Embolism, Mesenteric Artery Thrombosis
  1. See Also
    1. Mesenteric Ischemia
  2. Epidemiology
    1. Age over 60 years
  3. Causes
    1. Superior Mesenteric Artery Embolism (50%)
      1. Cardiac thrombus source is most common
      2. Asoociated with other emboli (20%)
        1. Malignancy
        2. Coagulation disorder
      3. Associated with underlying cardiovascular disease
        1. Cardiac Arrhythmia
        2. Myocardial Infarction
        3. Valvular Disease
    2. Superior Mesenteric Artery Thrombosis (15-25%)
      1. Underlying Chronic Mesenteric Ischemia
      2. Associated conditions
        1. Abdominal Trauma
        2. Acute infection
  4. Symptoms
    1. Vomiting
    2. Sudden severe Abdominal Pain
      1. Pain is out of proportion to physical findings
    3. Forceful bowel evacuation
  5. Diagnosis: Classic Triad on presentation
    1. Cardiac disease
    2. Acute Abdominal Pain
    3. Acute gastrointestinal emptying (Vomiting and forceful bowel evacuation)
  6. Labs
    1. Metabolic Acidosis
      1. Acute Abdominal Pain and Metabolic Acidosis is Acute Mesenteric Ischemia until definitively excluded
  7. Imaging
    1. Abdominal XRay
      1. Normal initially
      2. Late findings
        1. Thumb printing
        2. Pneumatosis
        3. Portal venous gas
    2. Angiography (gold standard)
    3. CT Abdomen (consider CT Angiography)
    4. MRA Abdomen
  8. Management
    1. Vascular Surgery for embolectomy
    2. Urokinase
      1. Schoots (2005) J Vasc Interventional Rad 16:317-29 [PubMed]
  9. Prognosis
    1. Mortality: 70-90%
  10. References
    1. Fraboni (2012) Board Review Express, San Jose

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