Minimally invasive management of acute superior mesenteric artery occlusion: combined urokinase and laparoscopic therapy.
Acute superior mesenteric arterial occlusion is a medical emergency mandating prompt diagnosis and therapy. Traditional management includes exploratory laparotomy with possible embolectomy or bowel resection. Unfortunately, these patients are often frail and elderly and tolerate open laparotomy poorly. In this report, we describe a patient with acute superior mesenteric artery occlusion successfully managed with a minimally invasive approach. The acute arterial occlusion was managed with intra-arterial fibrinolytic therapy, and bowel viability was assessed with diagnostic laparoscopy. This combined approach of arteriographic and laparoscopic therapy avoided exploratory laparotomy, and we believe that it is an important therapeutic option in select patients with acute mesenteric ischemia.
Regan
F
F
Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Karlstad
R R
RR
Magnuson
T H
TH
D000208:Acute Disease; D000368:Aged; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D003131:Combined Modality Therapy; D006801:Humans; D007422:Intestines / Q000473:pathology*; D010535:Laparoscopy; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging; D010960:Plasminogen Activators / Q000627:therapeutic use*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator