Vasc Spec Int.  2017 Sep;33(3):99-107. 10.5758/vsi.2017.33.3.99.

Effect of Clinical Suspicion by Referral Physician and Early Outcomes in Patients with Acute Superior Mesenteric Artery Embolism

• Kim HK
• Hwang D
• Park S
• Huh S
• Lee JM
• Yun WS
• Kim YW

• KMID: 2396189
• DOI: http://doi.org/10.5758/vsi.2017.33.3.99

Abstract

PURPOSE
To investigate the pattern of referral of patients with superior mesenteric artery embolism (SMAE) and its effect on outcomes, and to evaluate the risk factors for bowel infarction.
MATERIALS AND METHODS
This retrospective study included 66 consecutive patients diagnosed with acute SMAE between January 2001 and June 2016. Appropriate diagnosis by the referring physician was defined if the referral letter indicated that acute mesenteric ischemia was suspected or had been diagnosed at the referral center. Surgical delay was defined as the interval between symptom onset and surgery for definitive treatment.
RESULTS
Among 54 patients transferred from other centers, 26 patients (48.1%) were diagnosed appropriately by the referring physician. The rate of appropriate diagnosis was differed significantly by the use of computed tomography (CT) scan at referral center (25/35 with CT and 1/19 without CT, P=0.00). The surgical delay was significantly longer in patients without appropriate diagnosis compared with the patients with appropriate diagnosis (53.5±52.3 hours vs. 28.8±23.6 hours, P=0.04). Initially, 56 patients received surgical treatment with 31 underwent bowel resection due to infarction, 6 received conservative treatment, and the remaining 4 patients refused any treatment. The surgical delay, abdominal distension, tenderness, rebound tenderness, and level of C-reactive protein were associated with bowel infarction at initial operation. Overall in-hospital mortality was 32%.
CONCLUSION
A high index of suspicion with appropriate diagnostic modality, such as CT scan is crucial in patients with SMAE for reducing surgical delay as a risk factor of bowel infarction.

Keyword

Mesenteric artery; superior; Embolism; Atrial fibrillation; Intestines; Infarction

MeSH Terms

Atrial Fibrillation
C-Reactive Protein
Diagnosis
Embolism*
Hospital Mortality
Humans
Infarction
Intestines
Mesenteric Arteries
Mesenteric Artery, Superior*
Mesenteric Ischemia
Referral and Consultation*
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
C-Reactive Protein