Analyze the Optimal Management of Superior Mesenteric Artery (SMA) Occlusion
Subjects and methods：The characteristics of patients with SMA occlusion in this hospital between October 1, 2005 and September 30, 2012 were investigated retrospectively. Results: There were 10 cases of SMA occlusion, of which 4 were treated with interventional radiology (IVR), 2 required additional...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 34; no. 3; pp. 587 - 591 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society for Abdominal Emergency Medicine
31.03.2014
日本腹部救急医学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.34.587 |
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| Abstract | Subjects and methods：The characteristics of patients with SMA occlusion in this hospital between October 1, 2005 and September 30, 2012 were investigated retrospectively. Results: There were 10 cases of SMA occlusion, of which 4 were treated with interventional radiology (IVR), 2 required additional enterectomy after IVR treatment, and 4 were treated with enterectomy. The time from the onset to diagnosis was significantly shorter (6.8 hours vs. 29.1 hours, p<0.05) and the serum CRP significantly lower (0.5mg/dL vs. 13.9mg/dL, p<0.05) in the IVR group which showed improvement in response to the treatment (n=2) than in the intestinal necrosis group (n=8). The cutoff values of the two parameters were 2 hours and 0.2mg/dL, respectively. There were no abnormal findings on abdominal CT in the IVR group. Conclusion: IVR is considered as a worthwhile initial treatment modality in cases of SMA occlusion when the interval from onset to diagnosis is under 2 hours, the serum CRP is ≤0.2mg/dL, and abdominal CT reveals no abnormalities. |
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| AbstractList | Subjects and methods：The characteristics of patients with SMA occlusion in this hospital between October 1, 2005 and September 30, 2012 were investigated retrospectively. Results: There were 10 cases of SMA occlusion, of which 4 were treated with interventional radiology (IVR), 2 required additional enterectomy after IVR treatment, and 4 were treated with enterectomy. The time from the onset to diagnosis was significantly shorter (6.8 hours vs. 29.1 hours, p<0.05) and the serum CRP significantly lower (0.5mg/dL vs. 13.9mg/dL, p<0.05) in the IVR group which showed improvement in response to the treatment (n=2) than in the intestinal necrosis group (n=8). The cutoff values of the two parameters were 2 hours and 0.2mg/dL, respectively. There were no abnormal findings on abdominal CT in the IVR group. Conclusion: IVR is considered as a worthwhile initial treatment modality in cases of SMA occlusion when the interval from onset to diagnosis is under 2 hours, the serum CRP is ≤0.2mg/dL, and abdominal CT reveals no abnormalities.
目的：上腸間膜動脈（SMA）閉塞症の適切な治療方針を検討すること。対象と方法：2005年10月1日から2012年9月30日に当院でSMA閉塞症の診断で治療された症例の特徴を後方視的に検討した。結果：SMA閉塞症は10例で，治療はIVR 4例，IVR施行後に腸管切除術追加施行2例，腸管切除術4例であった。IVRで軽快した群（n＝2）は腸管壊死群（n＝8）より発症から診断までの時間が有意に短く（6.8 vs 29.1時間，p＜0.05），CRP値は有意に低かった（0.5 vs 13.9mg/dL，p＜0.05）。cut off値はそれぞれ2時間，0.2mg/dLであった。またIVRで軽快した群は腹部CTで異常所見を認めなかった。結論：SMA閉塞症で発症から診断まで2時間以内，CRP値が0.2mg/dL以下で，腹部CTで異常所見を認めない場合にはIVRはまず試みるべき治療と考えられる。 Subjects and methods：The characteristics of patients with SMA occlusion in this hospital between October 1, 2005 and September 30, 2012 were investigated retrospectively. Results: There were 10 cases of SMA occlusion, of which 4 were treated with interventional radiology (IVR), 2 required additional enterectomy after IVR treatment, and 4 were treated with enterectomy. The time from the onset to diagnosis was significantly shorter (6.8 hours vs. 29.1 hours, p<0.05) and the serum CRP significantly lower (0.5mg/dL vs. 13.9mg/dL, p<0.05) in the IVR group which showed improvement in response to the treatment (n=2) than in the intestinal necrosis group (n=8). The cutoff values of the two parameters were 2 hours and 0.2mg/dL, respectively. There were no abnormal findings on abdominal CT in the IVR group. Conclusion: IVR is considered as a worthwhile initial treatment modality in cases of SMA occlusion when the interval from onset to diagnosis is under 2 hours, the serum CRP is ≤0.2mg/dL, and abdominal CT reveals no abnormalities. |
| Author | Takahashi, Tetsuya Takemoto, Masaaki |
| Author_FL | 竹本 正明 高橋 哲也 |
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| Author_xml | – sequence: 1 fullname: Takahashi, Tetsuya organization: Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital – sequence: 1 fullname: Takemoto, Masaaki organization: Department of Emergency Medicine, Yokohama Sakae Kyosai Hospital |
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| DocumentTitleAlternate | 上腸間膜動脈閉塞症の治療方針の検討 |
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| PublicationTitle_FL | J Abdom Emerg Med 日本腹部救急医学会雑誌 日腹部救急医会誌 Journal of Abdominal Emergency Medicine Nihon Fukubu Kyukyu Igakkai Zasshi |
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| Publisher | Japanese Society for Abdominal Emergency Medicine 日本腹部救急医学会 |
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| References | 2) Cappell MS: Intestinal (mesenteric) vasculopathy. I. Acute superior mesenteric arteriopathy and venopathy. Gastroenterol Clin North Am 1998; 27: 783-825. 3) Oldenburg WA, Lau LL, Rodenberg TJ, et al: Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004; 164: 1054-1062. 9) Bassiouny HS: Nonocclusive mesenteric ischemia. Surg Clin North Am 1997; 77: 319-326. 12) 田村暢一朗，鶴田 淳，池田博斉，ほか：当院における上腸間膜動脈塞栓症の治療方針に関する後向き検討．日腹部救急医会誌2011；31：849-853 5) 茂木克彦，石飛幸三，関みな子，ほか：急性上腸間膜動脈閉塞症―閉塞部位と臨床経過について．日腹部救急医会誌1996；16：427-432 6) 谷掛雅人：救急のIVR 1．急性上腸間膜動脈閉塞症に対するIVR. IVR 2005；20：72-75 17) 飯田茂穂，中川原儀三，太田信次，ほか：塞栓摘除術後，second-look procedure，腸切除術にて救命し得た上腸間膜動脈塞栓症の1例．日腹部救急医会誌2004；24：133-136 7) Klein HM, Klosterhalfen B, Kinzel S, et al: CT and MRI of experimentally induced mesenteric ischemia in a porcine model. J Comput Assist Tomogr 1996; 20: 254-261. 1) Reinus JF, Brandt LJ, Boley SJ: Ischemic diseases of the bowel. Gastroenterol Clin North Am 1990; 19: 319-343. 4) 北村好史，横尾直樹，北角泰人，ほか：経カテーテル的バルーン血管拡張術により開腹術を回避しえた上腸間膜動脈閉塞症の1例．日救急医会誌2006；17：854-859 15) Calin GA, Calin S, Ionescu R, et al: Successful local fibrinolytic treatment and balloon angioplasty in superior mesenteric arterial embolism: a case report and literature review. Hepatogastroenterology 2003; 50: 732-734. 8) Batellier J, Kieny R: Superior mesenteric artery embolism: eighty-two cases. Ann Vasc Surg 1990; 4: 112-116. 10) Acosta S, Björck M: Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population. Eur J Vasc Endovasc Surg 2003; 26: 179-183. 16) 宗岡克樹，白井良夫，高木健太郎，ほか：急性上腸間膜動脈閉塞症に対するウロキナーゼ動注療法：2症例の報告．日消外会誌2001；34：495-499 11) 工藤大介，渡部広明，大須賀章倫，ほか：門脈ガス血症を併発した非閉塞性腸管虚血症（NOMI），腸管虚血か腸管壊死か対照的な2例．日救急医会誌2008；19：1101-1106 13) Heinrich PC, Castell JV, Andus T: Interleukin-6 and the acute phase response. Biochem J 1990; 265: 621-636. 14) Wakabayashi H, Shiode T, Kurose M, et al: Emergent treatment of acute embolic superior mesenteric ischemia with combination of thrombolysis and angioplasty: report of two cases. Cardiovasc Intervent Radiol 2004; 27: 389-393. |
| References_xml | – reference: 1) Reinus JF, Brandt LJ, Boley SJ: Ischemic diseases of the bowel. Gastroenterol Clin North Am 1990; 19: 319-343. – reference: 10) Acosta S, Björck M: Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population. Eur J Vasc Endovasc Surg 2003; 26: 179-183. – reference: 11) 工藤大介，渡部広明，大須賀章倫，ほか：門脈ガス血症を併発した非閉塞性腸管虚血症（NOMI），腸管虚血か腸管壊死か対照的な2例．日救急医会誌2008；19：1101-1106． – reference: 16) 宗岡克樹，白井良夫，高木健太郎，ほか：急性上腸間膜動脈閉塞症に対するウロキナーゼ動注療法：2症例の報告．日消外会誌2001；34：495-499． – reference: 5) 茂木克彦，石飛幸三，関みな子，ほか：急性上腸間膜動脈閉塞症―閉塞部位と臨床経過について．日腹部救急医会誌1996；16：427-432． – reference: 15) Calin GA, Calin S, Ionescu R, et al: Successful local fibrinolytic treatment and balloon angioplasty in superior mesenteric arterial embolism: a case report and literature review. Hepatogastroenterology 2003; 50: 732-734. – reference: 14) Wakabayashi H, Shiode T, Kurose M, et al: Emergent treatment of acute embolic superior mesenteric ischemia with combination of thrombolysis and angioplasty: report of two cases. Cardiovasc Intervent Radiol 2004; 27: 389-393. – reference: 12) 田村暢一朗，鶴田 淳，池田博斉，ほか：当院における上腸間膜動脈塞栓症の治療方針に関する後向き検討．日腹部救急医会誌2011；31：849-853． – reference: 6) 谷掛雅人：救急のIVR 1．急性上腸間膜動脈閉塞症に対するIVR. IVR 2005；20：72-75． – reference: 3) Oldenburg WA, Lau LL, Rodenberg TJ, et al: Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004; 164: 1054-1062. – reference: 4) 北村好史，横尾直樹，北角泰人，ほか：経カテーテル的バルーン血管拡張術により開腹術を回避しえた上腸間膜動脈閉塞症の1例．日救急医会誌2006；17：854-859． – reference: 8) Batellier J, Kieny R: Superior mesenteric artery embolism: eighty-two cases. Ann Vasc Surg 1990; 4: 112-116. – reference: 13) Heinrich PC, Castell JV, Andus T: Interleukin-6 and the acute phase response. Biochem J 1990; 265: 621-636. – reference: 7) Klein HM, Klosterhalfen B, Kinzel S, et al: CT and MRI of experimentally induced mesenteric ischemia in a porcine model. J Comput Assist Tomogr 1996; 20: 254-261. – reference: 17) 飯田茂穂，中川原儀三，太田信次，ほか：塞栓摘除術後，second-look procedure，腸切除術にて救命し得た上腸間膜動脈塞栓症の1例．日腹部救急医会誌2004；24：133-136． – reference: 2) Cappell MS: Intestinal (mesenteric) vasculopathy. I. Acute superior mesenteric arteriopathy and venopathy. Gastroenterol Clin North Am 1998; 27: 783-825. – reference: 9) Bassiouny HS: Nonocclusive mesenteric ischemia. Surg Clin North Am 1997; 77: 319-326. |
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| Title | Analyze the Optimal Management of Superior Mesenteric Artery (SMA) Occlusion |
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