BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,whic...BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,which progress rapidly and are easily misdiagnosed.Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases.This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture.On admission,he showed extremely unstable vital signs and was unconscious with a laceration on his head,heart rate of 143 beats/min,shallow and fast breathing(frequency>35 beats/min),and blood pressure as low as 20/10 mmHg(1 mmHg=0.133 kPa).Computed tomography revealed abdominal and pelvic hematocele effusion,suggesting active bleeding.The patient was suspected of partial rupture of the distal SMA branch.The patient underwent emergency mesenteric artery ligation,scalp suture,and liver laceration closure.In view of conditions with acute onset,rapid progression,and high bleeding volume,key points of nursing were conducted,including activating emergency protocol,opening of the green channel,and arranging relevant examinations with various medical staff for quick diagnosis.The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time.Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability.Strict measures were taken to avoid intraoperative hypothermia and infection.CONCLUSION After 3.5 h of emergency rescue and medical care,bleeding was successfully controlled,and the patient’s condition was stabilized.Subsequently,the patient was transferred to the intensive care unit for continuous monitoring and treatment.On the sixth day,the patient was weaned off the ventilator,extubated,and relocated to a specialized ward.Through diligent medical intervention and attentive nursing,the patient made a full recovery and was discharged on day 22.The follow-up visit confirmed the patient’s successful recovery.展开更多
AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-sub-acute portal vein and superior mesenteric vein throm-bosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 male...AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-sub-acute portal vein and superior mesenteric vein throm-bosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were ac-curately diagnosed with Doppler ultrasound scans, com-puted tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutane-ous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased signif icantly. Symptoms in these 45 patients were improved dramatically without severe operationalcomplications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi reformed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.展开更多
Diagnosis of acute arterial mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal phase.Most patients ...Diagnosis of acute arterial mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal phase.Most patients have acute superior mesenteric artery(SMA)occlusion,and a large proportion of these patients will develop peritonitis prior to mesenteric revascularization,and explorative laparotomy will therefore be necessary to evaluate the extent and severity of intestinal ischemia,and to perform bowel resections.The establishment of a hybrid operating room in vascular units in hospitals is most important to be able to perform successful intestinal revascularization.This review outlines current frontline surgical strategies to improve survival and minimize bowel morbidity in patients with peritonitis secondary to acute SMA occlusion.Explorative laparotomy needs to be performed first.Curative treatment is based upon intestinal revascularization followed by bowel resection.If no vascular imaging has been carried out,SMA angiography is performed.In case of embolic occlusion of the SMA,open embolectomy is performed followed by angiography.In case of thrombotic occlusion,the occlusive lesion can be recanalized retrograde from an exposed SMA,the guidewire snared from either the femoral or brachial artery,and stented with standard devices from these access sites.Bowel resections and sometimes gall bladder removal due to transmural infarctions are performed at initial laparotomy,leaving definitive bowel reconstructions to a planned second look laparotomy,according to the principles of damage control surgery.Patients with peritonitis secondary to acute SMA occlusion should be managed by both the general and vascular surgeon,and a hybrid revascularization approach is of utmost importance to improve outcomes.展开更多
目的探讨症状性孤立性肠系膜上动脉夹层(ISMAD)患者保守治疗与腔内治疗的效果。方法检索Web of Science、PubMed、中国知网、万方数据库中ISMAD患者保守治疗与腔内治疗效果,检索时间为建库至2022年10月1日,采用RevMan 5.3统计软件对文...目的探讨症状性孤立性肠系膜上动脉夹层(ISMAD)患者保守治疗与腔内治疗的效果。方法检索Web of Science、PubMed、中国知网、万方数据库中ISMAD患者保守治疗与腔内治疗效果,检索时间为建库至2022年10月1日,采用RevMan 5.3统计软件对文献进行Meta分析。结果共纳入文献11篇,664例ISMAD。Meta分析结果显示,腔内治疗组患者治疗有效率、远期夹层重塑率均明显高于保守治疗组患者,差异均有统计学意义(P﹤0.01)。两组患者腹痛复发率比较,差异无统计学意义(P﹥0.05)。结论腔内治疗ISMAD患者有效率、夹层重塑率均高于保守治疗,两者复发性腹痛发生率无差异,因此腔内治疗ISMAD值得在临床上进一步推广应用。展开更多
孤立性肠系膜上动脉夹层(isolated dissection of the superior mesenteric artery,IDSMA)曾被认为是一种罕见病。近年来,随着增强CT的广泛应用,越来越多的IDSMA被报道,其中来自于中国的病例数量最多。本文对国内报道的IDSMA的临床数据...孤立性肠系膜上动脉夹层(isolated dissection of the superior mesenteric artery,IDSMA)曾被认为是一种罕见病。近年来,随着增强CT的广泛应用,越来越多的IDSMA被报道,其中来自于中国的病例数量最多。本文对国内报道的IDSMA的临床数据进行汇总、分析,并将部分数据与国外数据进行对比,以期反映国内诊治IDSMA的临床现状。展开更多
基金Supported by The Health Science and Technology Program of Zhejiang Province,No.2022KY836.
文摘BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,which progress rapidly and are easily misdiagnosed.Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases.This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture.On admission,he showed extremely unstable vital signs and was unconscious with a laceration on his head,heart rate of 143 beats/min,shallow and fast breathing(frequency>35 beats/min),and blood pressure as low as 20/10 mmHg(1 mmHg=0.133 kPa).Computed tomography revealed abdominal and pelvic hematocele effusion,suggesting active bleeding.The patient was suspected of partial rupture of the distal SMA branch.The patient underwent emergency mesenteric artery ligation,scalp suture,and liver laceration closure.In view of conditions with acute onset,rapid progression,and high bleeding volume,key points of nursing were conducted,including activating emergency protocol,opening of the green channel,and arranging relevant examinations with various medical staff for quick diagnosis.The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time.Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability.Strict measures were taken to avoid intraoperative hypothermia and infection.CONCLUSION After 3.5 h of emergency rescue and medical care,bleeding was successfully controlled,and the patient’s condition was stabilized.Subsequently,the patient was transferred to the intensive care unit for continuous monitoring and treatment.On the sixth day,the patient was weaned off the ventilator,extubated,and relocated to a specialized ward.Through diligent medical intervention and attentive nursing,the patient made a full recovery and was discharged on day 22.The follow-up visit confirmed the patient’s successful recovery.
基金Supported by The National Natural Science Foundation, Project No. 30670606Chinese army "Eleventh Five-Year Plan" Research Fund, Project No. 06MA263
文摘AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-sub-acute portal vein and superior mesenteric vein throm-bosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were ac-curately diagnosed with Doppler ultrasound scans, com-puted tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutane-ous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased signif icantly. Symptoms in these 45 patients were improved dramatically without severe operationalcomplications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi reformed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.
文摘Diagnosis of acute arterial mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal phase.Most patients have acute superior mesenteric artery(SMA)occlusion,and a large proportion of these patients will develop peritonitis prior to mesenteric revascularization,and explorative laparotomy will therefore be necessary to evaluate the extent and severity of intestinal ischemia,and to perform bowel resections.The establishment of a hybrid operating room in vascular units in hospitals is most important to be able to perform successful intestinal revascularization.This review outlines current frontline surgical strategies to improve survival and minimize bowel morbidity in patients with peritonitis secondary to acute SMA occlusion.Explorative laparotomy needs to be performed first.Curative treatment is based upon intestinal revascularization followed by bowel resection.If no vascular imaging has been carried out,SMA angiography is performed.In case of embolic occlusion of the SMA,open embolectomy is performed followed by angiography.In case of thrombotic occlusion,the occlusive lesion can be recanalized retrograde from an exposed SMA,the guidewire snared from either the femoral or brachial artery,and stented with standard devices from these access sites.Bowel resections and sometimes gall bladder removal due to transmural infarctions are performed at initial laparotomy,leaving definitive bowel reconstructions to a planned second look laparotomy,according to the principles of damage control surgery.Patients with peritonitis secondary to acute SMA occlusion should be managed by both the general and vascular surgeon,and a hybrid revascularization approach is of utmost importance to improve outcomes.
文摘目的探讨症状性孤立性肠系膜上动脉夹层(ISMAD)患者保守治疗与腔内治疗的效果。方法检索Web of Science、PubMed、中国知网、万方数据库中ISMAD患者保守治疗与腔内治疗效果,检索时间为建库至2022年10月1日,采用RevMan 5.3统计软件对文献进行Meta分析。结果共纳入文献11篇,664例ISMAD。Meta分析结果显示,腔内治疗组患者治疗有效率、远期夹层重塑率均明显高于保守治疗组患者,差异均有统计学意义(P﹤0.01)。两组患者腹痛复发率比较,差异无统计学意义(P﹥0.05)。结论腔内治疗ISMAD患者有效率、夹层重塑率均高于保守治疗,两者复发性腹痛发生率无差异,因此腔内治疗ISMAD值得在临床上进一步推广应用。
文摘孤立性肠系膜上动脉夹层(isolated dissection of the superior mesenteric artery,IDSMA)曾被认为是一种罕见病。近年来,随着增强CT的广泛应用,越来越多的IDSMA被报道,其中来自于中国的病例数量最多。本文对国内报道的IDSMA的临床数据进行汇总、分析,并将部分数据与国外数据进行对比,以期反映国内诊治IDSMA的临床现状。
