title: Management of Acute Superior Mesenteric Artery Occlusion by Thrombolytic Therapy.
abstract: Acute occlusion of the superior mesenteric artery (SMA) causes extensive bowel necrosis, resulting in a poor prognosis with an extremely high mortality rate. An 82-year-old woman was admitted to our hospital with the complaint of abdominal pain. She was diagnosed as having acute SMA occlusion by enhanced CT. Five hours from onset, the first thrombolytic therapy with urokinase was performed, but failed to complete thrombolysis and recanalization of peripheral blood flow. An exploratory laparotomy following the first thrombolytic therapy showed a mild ischemic change in the affected intestine and mesentery, but no sign of necrosis. After the laparotomy, local thrombolytic therapy with angiographic evaluation of blood flow at 24, 36 and 48 h from the first thrombolysis was performed. As a result, the residual thrombus disappeared and all branches of the SMA became well visualized. The patient was discharged well without a second-look operation or major bowel resection. Sequential intermittent thrombolytic therapy with meticulous angiographic evaluation of blood flow is effective for early-stage acute SMA occlusion.
authors.affiliation: Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okamura
authors.forename: Hitoshi
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authors.lastname: Fujiwara
authors.forename: Teruhisa
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authors.lastname: Sonoyama
authors.forename: Toshiya
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authors.lastname: Ochiai
authors.forename: Hisashi
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authors.lastname: Ikoma
authors.forename: Takeshi
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authors.lastname: Kubota
authors.forename: Masayoshi
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authors.lastname: Nakanishi
authors.forename: Shojiro
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authors.lastname: Kikuchi
authors.forename: Daisuke
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authors.lastname: Ichikawa
authors.forename: Kazuma
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authors.lastname: Okamoto
authors.forename: Chohei
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authors.lastname: Sakakura
authors.forename: Yukihito
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authors.lastname: Kokuba
authors.forename: Hiroki
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji