II. Epidemiology

  1. Age over 60 years

III. 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

IV. Symptoms

  1. Vomiting
  2. Sudden severe Abdominal Pain
    1. Pain is out of proportion to physical findings
  3. Forceful bowel evacuation

V. Diagnosis: Classic Triad on presentation

  1. Cardiac disease
  2. Acute Abdominal Pain
  3. Acute gastrointestinal emptying (Vomiting and forceful bowel evacuation)

VII. 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

VIII. Management

  1. Vascular Surgery for embolectomy
  2. Urokinase
    1. Schoots (2005) J Vasc Interventional Rad 16:317-29 [PubMed]

IX. Prognosis

  1. Mortality: 70-90%

X. References

  1. Fraboni (2012) Board Review Express, San Jose

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