Mesenteric arterial occlusion as a vascular emergency

Galloway, J. M. D.; Walker, Patricia; Mavor, G. E.

doi:10.1002/bjs.1800560608

Cited by 8 publications

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References 13 publications

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“…2, 3,4 The situation with cases of acute superior mesenteric artery occlusion with gangrene of the gut on the other hand has shown a high mortality and few cases have been reported of a successful outcome following surgery.4 Successful outcome following surgery has been reported. 4,2,6,7 Cases are on record where after superior mesenteric artery occlusion bowel resection has not proved necessary following embolectomy4, 7, 8 but cases of this kind are rare. Some authors advocate a second look operation in cases where there is gangrene of the small bowel and resection is not feasible because of its extent,6, 7, 9 and they recommend a two stage procedure of embolectomy and/or endarterectomy with exploration 1-2 days later.…”

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A Case Report of Superior Mesenteric Artery Occlusion

Prockter

1972

Angiology

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A case is reported of survival following acute superior mesenteric artery occlusion in which endarterectomy led to recovery of gut of doubtful viability and enabled a useful and significant portion of the gut to be retained.Acute superior mesenteric artery occlusion with gangrene of the gut has shown a high mortality and few cases have been reported of a successful outcome following surgery. The interest in this case is that following surgery the patient survived and the portion of gut retained was of sufficient proportions to maintain the patient in a satisfactory state of nutrition. CASE REPORTAn elderly man of 77 years presented as an acute admission with abdominal pain which began gradually four hours prior to admission and by the time of admission was severe and unremitting. The pain was midline and periumbilical in distribution and was accompanied by severe vomiting. He had had a normal bowel action that morning. He said that he had occasionally complained of stomach pains and that this had shown no relationship to meals, but he was a poor historian and it was doubtful whether his history was entirely reliable. He had had previous good health and no previous admission to hospital, this was confirmed by his family.On examination he was a thin elderly man who was obviously in very severe abdominal pain. Despite this he had a remarkable scarcity of signs on abdominal palpation. There was some degree of guarding which was considered to be voluntary and it was possible to palpate beyond this without further distressing the patient. The absence of tenderness was also noteworthy. There was no abdominal distension. Bowel sounds were present. Rectal examination revealed a moderate degree of faecal impaction, but was otherwise unrevealing. Investigations X-Ray abdomen with erect and supine films showed one fluid level in the erect film to the right of the midline.Haemoglobin was 14.9 grams. Evaluation of signs and symptoms was difficult but in the presence of abdominal pain which did not improve with analgesics and a significant fluid level laparotomy was thought to be justified and was undertaken five hours following admission. at FLORIDA INTERNATIONAL UNIV on June 12, 2015 ang.sagepub.com Downloaded from 219 FIG. 1. (A) Atheroma occluding artery distal to middle colic branch artery. (B) Definitely viable gut. (C) Doubtful viable gut. (D) Gangrenous gut. (E) lst Jejunal branch artery. at FLORIDA INTERNATIONAL UNIV on June 12, 2015 ang.sagepub.com Downloaded from 220Operative findings The small bowel was found to be non viable, and gangrenous along most of the small intestine and ascending colon with a clear line of demarcation at the hepatic flexure. Non viable gut extended proximally to an area of doubtful viability the extent of which was uncertain. Pink normal gut was present in a segment of less than five feet from the duodeno-jejunal flexure.The peritoneal cavity contained foul smelling cloudy fluid and there was moderate peritonitis.The superior mesenteric artery was located and found to be completely occluded...

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A Case Report of Superior Mesenteric Artery Occlusion

Prockter

1972

Angiology

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Superior mesenteric embolectomy

Jago

1971

Journal of British Surgery

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A 57‐year‐old woman with embolic occlusion of the superior mesenteric artery was treated by embolectomy. It is remarkable that it has been possible to trace only 4 previous reports of successful embolectomy in the British literature. In view of the simplicity of the techniques involved this must be due to a failure of early diagnosis, resulting principally from the lack of abdominal signs characteristic of the condition. The common clinical findings are reviewed.

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Akute intestinale Ischämie

Luther

2001

Intestinale Durchblutungsstörungen

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Mesenteric arterial occlusion as a vascular emergency

Cited by 8 publications

References 13 publications

A Case Report of Superior Mesenteric Artery Occlusion

A Case Report of Superior Mesenteric Artery Occlusion

Superior mesenteric embolectomy

Akute intestinale Ischämie

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