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Updated: May 12, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Treatment outcome in patients with acute superior mesenteric artery embolism
Woo-Sung Yun1, Kyung Keun Lee, Jayun Cho
1Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea.
Purpose:
The goals of this study were to investigate the treatment outcomes of acute mesenteric ischemia caused by superior mesenteric artery (SMA) embolism and identify the posttreatment prognostic factors.
Methods:
The clinical data of 32 episodes of acute SMA embolism in 30 patients, including 2 recurrent cases, between April 2003 and March 2011 were retrospectively reviewed.
Results:
Median patient age was 74 years (range, 39-89 years), and 50% were male. Conservative treatment, including bowel rest, nasogastric drainage, intravenous fluid therapy, parenteral nutritional support, and anticoagulation therapy, was undertaken in 5 patients with no clinical evidence of bowel gangrene, including 1 with recurrent ischemia. No deaths occurred among patients treated conservatively. A total of 27 patients were treated with open surgical repair (25 embolectomies and 2 bowel resections alone). Among 25 patients treated with embolectomy, 14 required bowel resection. Most bowel resections (94%, 15/16) were limited, with the remaining length of small bowel greater than 150 cm, which could not cause short bowel syndrome. In-hospital mortality of surgery was 30%. No variables were associated with mortality after surgical intervention, including, age, gender, presence of bowel gangrene, and symptom duration. The overall 1-, 3-, and 5-year survival rates after initial successful treatment were 96%, 73%, and 44%, respectively, regardless of treatment type.
Conclusions:
Prompt diagnosis and treatment before extensive irreversible gangrene is the mainstay in the treatment of SMA embolism. Limited bowel gangrene was not associated with mortality.
Insights
Prompt diagnosis and treatment of superior mesenteric artery (SMA) embolism are crucial for survival. Early intervention, even with limited bowel gangrene, improves outcomes in acute mesenteric ischemia.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Emergency Medicine
Background:
- Acute mesenteric ischemia due to superior mesenteric artery (SMA) embolism is a critical condition.
- Timely diagnosis and intervention are vital for patient survival.
Purpose of the Study:
- To evaluate treatment outcomes for acute SMA embolism.
- To identify prognostic factors influencing patient survival after treatment.
Main Methods:
- Retrospective review of clinical data from 30 patients (32 episodes) with acute SMA embolism.
- Analysis of conservative and surgical treatment approaches, including embolectomy and bowel resection.
Main Results:
- Conservative treatment in 5 patients with no gangrene resulted in no deaths.
- Surgical repair in 27 patients had a 30% in-hospital mortality rate.
- Overall 1-, 3-, and 5-year survival rates were 96%, 73%, and 44%, respectively; limited bowel gangrene did not impact mortality.
Conclusions:
- Prompt diagnosis and treatment are essential for managing SMA embolism.
- Early intervention can prevent extensive irreversible gangrene and improve survival.
- Limited bowel gangrene is not a predictor of mortality in SMA embolism.
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