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