Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population.

OBJECTIVES

to characterize the clinical presentation of patients with acute thrombo-embolic occlusion of the superior mesenteric artery (SMA).

DESIGN

prospective study.

MATERIALS

twenty-four consecutive patients admitted to Blekinge County Hospital, Karlskrona, Sweden, with acute thrombo-embolic occlusion of the SMA, over a three-year period from April 1999 through March 2002.

METHODS

clinical data were registered prospectively. Incidence, diagnostic procedures and factors associated with survival were analysed.

RESULTS

the diagnosis was verified at operation in 20, and at autopsy in 4 patients. The incidence was 5.3 per 100 000 inhabitants per year. Among the 20 patients with embolic disease, atrial fibrillation was present in 95%, synchronous embolic events in 30% and warfarin treatment in 10%. D-dimer was elevated on admission in 13/13. Four patients were diagnosed at first consultation. Fifteen underwent curative revascularisation (6) or bowel resection only (9). Five were alive at one-year follow-up, of whom one had short bowel syndrome. Length of bowel ischaemia predicted institutional (p = 0.004) and one-year mortality (p = 0.005).

CONCLUSIONS

the incidence was higher than expected. Embolic occlusions predominated. Old age, atrial fibrillation, severe abdominal pain and synchronous embolus suggest the diagnosis of acute bowel ischaemia. Length of bowel ischaemia predicted outcome.