Intraarterial Infusion of Urokinase for Acute Superior Mesenteric Artery Occlusion: A Report of Two Cases

Katsuki Muneoka¹⁾, Yoshio Shirai²⁾, Kentaro Takagi³⁾ and Takanobu Koyama³⁾

Department of Surgey, Niitsu Medical Center Hospital¹⁾ Department of Surgery, Niigata University School of Medicine²⁾ Department of Surgey, Niigata Prefectural Central Hospital³⁾

We report two cases of embolic occlusion of the superior mesenteric artery (SMA) treated by urokinase infusion into the SMA through angiographic catheter. A 59-year-old man (case no. 1) with acute abdomen underwent abdominal angiography, which revealing complete occlusion of the SMA trunk. Immediately after transcatheter infusion of urokinase (600,000 IU), 3.5 hours after the onset symptoms, the embolic occlusion and symptoms resolved. The patient recovered well without laparotomy and was discharged 1 month later. A 68-year-old man (case no. 2) with acute abdomen underwent abdominal angiography, revealing complete occlusion of SMA. Transcatheter infusion of urokinase (600,000 IU) resulted in resolution of the embolus 6.5 hours after the onset of symptoms. Although his symptoms and signs improved temporarily, they became exacerbated 3 hours after recanalization of the SMA. Laparotomy was performed, and a necrotic small bowel segment measuring 280 cm was resected. The postoperative course was complicated by acute respiratory distress syndrome, and the patient died of multiple organ failure 4 months after the operation. The experience with our cases and a review literature suggested that the outcome of intra-arterial infusion of urokinase depends on the viability of the bowel at the time of treatment, and this treatment may only be successful if instituted within 5 hours after the onset of embolic occlusion of SMA. In conclusion, intra-arterial infusion of urokinase may only be effective in the early phase of acute SMA occlusion.

Key words
acute superior mesenteric artery occlusion, superior mesenteric artery embolism, intraarterial infusion of urokinase

Reprint requests
Katsuki Muneoka Department of Surgery, Niigata University School of Medicine 1-757 Asahimachi-dori, Niigata City, 951-8510 JAPAN

Accepted
January 31, 2001

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