A Case Report of Acute Superior Mesenteric Arterial Occlusion Effectively Treated by Urokinase Infusion

Hiroshi Yoshida, Masahiko Onda, Takashi Tajiri, D.Y. Kim, Shigeki Okazaki, Matsuomi Umehara, Yasuhiro Mamada, Nobuhiko Taniai, Hideki Nishikubo, Tadashi Teramoto, Hiroyuki Tajima*, Tatsuo Kumasaki*, Kin-ichi Ebata*

First Department of Surgery, Department of Radiology*, Nippon Medical School

A 56-year-old man with atrial fibrillation was admitted to our hospital because of abdominal pain, nausea and vomiting of 3 hours' duration. Four hours after onset, abdominal angiography was performed, and complete occlusion of the superior mesenteric artery (SMA) was found. After 1 hour's direct infusion of high-dose urokinase (600,000 U/h) into the SMA, perfusion of the SMA was markedly improved and the abdominal pain disappeared. Then continuous infusion of low-dose urokinase (20,000 U/h) was selected. After 9 hours of infusion therapy, right lower abdominal pain and melena appeared. Angiography revealed an avascular area of the peripheral ileocolic artery. Emergency laparotomy revealed necrosis of the cecum and ileocecal resection was performed. The rest of the hospital stay was uneventful and the patient was discharged.

Key words
acute superior mesenteric arterial occlusion, urokinase infusion, acute abdomen

Reprint requests
Hiroshi Yoshida First Department of Surgery, Nippon Medical School
1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
April 17, 1991

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