Bonardelli S, Cangiotti L, Pinelli D, Pouchè A, Giulini S M
Department of General Surgery, University of Brescia, Italy.
J Cardiovasc Surg (Torino). 1994 Apr;35(2):169-71.
The paper presents a rare case of iatrogenic embolization of the superior mesenteric artery which required an emergency operation after an unsuccessful fibrinolytic treatment. An old woman, who had undergone renal percutaneous angioplasty (r-PTA), presented sudden but transient abdominal pain. Angiographic control of the angioplasty showed the goal of r-PTA but also an embolic occlusion of the main trunk of the superior mesenteric artery that did not respond to a selective fibrinolytic treatment. Within a few hours, the abdominal pain appeared again and induced an exploratory laparotomy which showed an extensive ischaemia of the whole jejunum. A successful embolectomy was performed associated with the resection of about 20 cm of necrotic jejunum. The postoperative period was uncomplicated. The case underlines several topics: close collaboration is necessary between interventional radiologists and surgeons in order to get a surgical "stand-by" during PTA procedures; the embolic occlusion of the superior mesenteric artery can produce irreversible, even if segmentary intestinal damage, also within a very short time after onset and, therefore, it seems to be at high risk for a fibrinolytic approach.
本文报道了一例罕见的医源性肠系膜上动脉栓塞病例，在纤维蛋白溶解治疗失败后需要进行急诊手术。一名接受过肾动脉经皮血管成形术（r-PTA）的老年女性突然出现短暂性腹痛。血管成形术的血管造影检查显示r-PTA达到了预期效果，但同时也发现肠系膜上动脉主干出现栓子阻塞，且对选择性纤维蛋白溶解治疗无反应。数小时内，腹痛再次出现，遂进行剖腹探查术，结果显示整个空肠广泛缺血。成功进行了栓子切除术，并切除了约20厘米坏死空肠。术后恢复顺利。该病例凸显了几个问题：介入放射科医生和外科医生之间密切合作很有必要，以便在PTA手术期间随时进行手术支援；肠系膜上动脉的栓子阻塞即使在发病后很短时间内也可能导致不可逆的节段性肠损伤，因此，纤维蛋白溶解治疗的风险似乎很高。
