Abstract
Ten cases of acute superior mesenteric arterial (SMA) occlusion were subjected to a clinical study of diagnosis, treatment, and prognosis.
The occlusion of SMA was correctly diagnosed in 14% by ultrasonography, in 40% by computed tomography, and in 100% by angiography. Therefore angiography should be performed in all suspicious cases of SMA occlusion. Eight of 10 patients were operated on. Two remaining patients were inoperable because of synchronous embolisms in other arteries as well as poor general condition. In 8 operated patients selective intraarterial infusion of urokinase, a fibrinolysis agent, followed by laparotomy saved lives in 2 and embolectomy did in one, whereas 3 out of 5 undergone bowel resection died. Bowel resection rate was 0% (0/3) in patients treated within 10 hours after the onset of symptoms versus 100% (5/5) in those whose treatment was delayed beyond 10 hours, with a significant difference (p<0.05). From these findings, the importance of early diagnosis and immediate treatment within 10 hours after the onset is emphasized. We think that intra arterial infusion of urokinase can be the first-choice regimen for SMA occlusion without bowel infarction.
