title: Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion.
abstract: BACKGROUND
  Acute superior mesenteric artery (SMA) occlusion leads to acute intestinal ischemia and is associated with high mortality. Early diagnosis is often missed, and confounding factors leading to diagnostic delays need to be highlighted.
  
  
  OBJECTIVE
  To identify potential diagnostic laboratory pitfalls at admission in patients with acute SMA occlusion.
  
  
  METHODS
  Fifty-five patients with acute SMA occlusion were identified from the in-hospital register during a 4-year period, 2005-2009.
  
  
  RESULTS
  The median age was 76 years; 78% were women. The occlusion was embolic in 53% and thrombotic in 47% of patients. At admission, troponin I was above the clinical decision level (> 0.06 μg/L) for acute ischemic myocardial injury in 9/19 (47%) patients with embolic occlusion. Elevated pancreas amylase and normal plasma lactate were found in 12/45 and 13/27, respectively. A troponin I (TnI) above the clinical decision level was associated with a high frequency of referrals from the general surgeon to a specialist in internal medicine (p = 0.011) or a cardiologist (p = 0.024). The diagnosis was established after computed tomography angiography in 98% of the patients. The overall in-hospital mortality rate was 33%. Attempting intestinal revascularization (n = 43; p < 0.001), with a 95% frequency rate of completion control of the vascular procedure, was associated with a higher survival rate, whereas referral to the cardiologist was associated with a higher mortality rate (p = 0.018).
  
  
  CONCLUSIONS
  Elevated TnI was common in acute SMA occlusion, and referral to the cardiologist was found to be associated with adverse outcome. Elevated pancreas amylase and normal plasma lactate values are also potential pitfalls at admission in patients with acute SMA occlusion.
authors.affiliation: Vascular Center, Malmö University Hospital, Malmö, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Acosta
authors.forename: Tomas
authors.initials: T
authors.lastname: Block
authors.forename: Steinarr
authors.initials: S
authors.lastname: Björnsson
authors.forename: Timothy
authors.initials: T
authors.lastname: Resch
authors.forename: Martin
authors.initials: M
authors.lastname: Björck
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Nilsson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000378:metabolism; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008099:Liver / Q000201:enzymology; D008297:Male; D017538:Mesenteric Artery, Superior; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D008875:Middle Aged; D010179:Pancreas / Q000201:enzymology; D011379:Prognosis; D015996:Survival Rate; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I; D019344:Lactic Acid; D000681:Amylases