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Cited by 65Abdominal vascular conditions and treatmentsAortic Thrombus and EmbolismVascular anomalies and interventions

Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion

Acosta, Stefan, Block, Tomas, Björnsson, Steinarr, Resch, Timothy, Björck, Martin, Nilsson, Torbjörn·2012·The Journal of Emergency Medicine
DOI 10.1016/j.jemermed.2011.03.036
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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.Objectives 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).Conclusion 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.

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  • Progress in management of specific forms of acute mesenteric ischaemia has been achieved, concerning mainly endovascular and hybrid therapy of occlusive arterial acute mesenteric ischaemia.

    “progress in management of specific forms of AMI has been achieved, concerning mainly the endovascular and hybrid therapy of occlusive arterial AMI.6 123”

    From Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis (2022) · cites this paper as [123]

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Authors
Acosta, S., Block, T., Björnsson, S., Resch, T., Björck, M., & Nilsson, T.
Affiliations
  • Skåne University Hospital (SE)
  • Uppsala University (SE)
  • Örebro University Hospital (SE)
Corresponding author
Acosta, Stefan
ORCID
Venue
The Journal of Emergency Medicine
Publisher
Elsevier BV
Published
2012-06
Volume
42
Issue
6
Pages
635-641
ISSN
0736-4679 (ISSN-L)
DOI
10.1016/j.jemermed.2011.03.036
OpenAlex
W2040633212
Cited by
65
References
21
Citations by year
2026: 4 · 2025: 4 · 2024: 6 · 2023: 7 · 2022: 3 · 2021: 5 · 2020: 5 · 2019: 3 · 2018: 4 · 2017: 5 · 2016: 4 · 2015: 5 · 2014: 3 · 2013: 5 · 2012: 1
FWCI
4.56
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Journal of Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Thrombus and Embolism
  • Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
Keywords
superior mesenteric artery occlusion, acute mesenteric ischemia, diagnostic pitfalls, troponin I, myocardial injury, plasma lactate, delayed diagnosis, embolic occlusion, thrombotic occlusion, CT angiography, intestinal revascularization, cardiologist referral, in-hospital mortality
MeSH terms
Acute Disease, Aged, Aged, 80 and over, Amylases, Female, Humans, Liver, Male, Mesenteric Vascular Occlusion, Middle Aged, Pancreas, Prognosis, Survival Rate, Hospital Mortality, Mesenteric Artery, Superior, Troponin I, Lactic Acid

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