급성 장간막 허혈증의 임상적 경험
A Clinical Review of Acute Mesenteric Ischemia
Korean J Vasc Endovasc Surg 2007; 23(2): 163-167
Published online November 30, -0001
Copyright © The Korean Society for Vascular Surgery.
Purpose: Acute mesenteric ischemia (AMI) is difficult to diagnose and has a high rate of complications as well as a high mortality rate. The aim of this study was to define the risk factors and mortality rate of patients with acute mesenteric ischemia. Method: We retrospectively reviewed 18 patients with acute mesenteric ischemia at the Kangbuk Samsung Hospital from June 1995 to May 2006. Result: The mean age was 51.1 (age range, 27 to 78 years) and the gender ratio was 2：1 (male, 18, female, 6). The most common underlying diseases were hypertension (50%, n=9), diabetes mellitus (44.4%, n=8), artrial fibrillation (22%, n=4), and congestive heart failure (11%, n=2). Abdominal pain was the most frequent presenting symptom; other symptoms included nausea, vomiting and hematochezia. To confirm the diagnosis, a CT was performed in 10 cases, a CT and angiography was performed in four cases, and exploratory surgery in four cases. The causes of the acute mesenteric ischemia were SMA embolism in eight cases (44%), SMA thrombosis in 5 cases (27%), SMA with IMA thrombosis in 1 case (5%), IMA thrombosis in 1 case (5%), SMV thrombosis in 2 cases (11%), and SMV with IMV thrombosis in 1 case (5%). All of the patients underwent abdominal exploration, 16 cases had bowel resection performed, one case had a thromboembolectomy performed, and one case was opened and closed. Complications occurred in nine (50%) patients. Sepsis in three, wound infection in three, short bowel syndrome, toxic hepatitis, pulmonary embolism, and ischemic heart disease also occurred. The overall mortality rate was 33.3% (6 cases). The mortality rate with a SMA embolism was 5% (1 case), with SMA thrombosis was 40% (2 cases), with SMA+IMA thrombosis was 100% (1 case), in IMA thrombosis 100% (1 case), in SMV thrombosis was 0%, and 100% in SMV+IMV thrombosis. Conclusion: Despite the low incidence of acute mesenteric ischemia, it is still a life-threatening condition. Thus, when mesenteric ischemia is suspected, early diagnosis, with CT or angiography is required, and thrombolytics and surgery should be considered to improve the prognosis.
Acute mesenteric ischemia, Embolism, Thrombosis