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Multimodality Diagnosis of Mesenteric Ischemia
05:07

Multimodality Diagnosis of Mesenteric Ischemia

Published on: July 21, 2023

Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery--a population-based study

S Acosta1, M Ogren, N-H Sternby

  • 1Department of Surgery, Blekinge County Hospital, Karlskrona, Sweden.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|January 14, 2004
PubMed
Abstract

Insights

Acute thrombo-embolic occlusion of the superior mesenteric artery (AOSMA) is more common and deadly than previously thought. This population-based autopsy study found a high mortality rate and infrequent pre-diagnosis suspicion.

Area of Science:

  • Vascular Surgery
  • Gastroenterology
  • Epidemiology

Background:

  • Acute thrombo-embolic occlusion of the superior mesenteric artery (AOSMA) is a critical vascular emergency.
  • Previous incidence and mortality data for AOSMA are primarily derived from clinical series, potentially underestimating its true prevalence.

Purpose of the Study:

  • To determine the population-based incidence of AOSMA with intestinal gangrene.
  • To assess the mortality rate associated with AOSMA.
  • To evaluate the diagnostic suspicion of AOSMA prior to death.

Main Methods:

  • A population-based study utilizing clinical and forensic autopsies from Malmö, Sweden (1970-1982).
  • Analysis included 23,446 clinical and 7,569 forensic autopsies, with an 87% autopsy rate.
  • Incidence calculated for AOSMA with intestinal gangrene among autopsies coded for bowel ischemia; operative procedures were also reviewed.

Main Results:

  • AOSMA with intestinal gangrene was identified in 213 autopsies (2 forensic, 211 clinical).
  • The incidence was 8.6 per 100,000 person-years, increasing with age (p<0.001).
  • Mortality was high at 93%, with only 33% of cases having prior suspicion of intestinal ischemia; 16 patients underwent surgery.

Conclusions:

  • The incidence and mortality of AOSMA are higher than reported in previous clinical studies.
  • Diagnosis of AOSMA is rarely suspected before death, highlighting a significant clinical challenge.
  • Findings underscore the need for improved diagnostic strategies and awareness of AOSMA.

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