Clinical Misdiagnosis of Acute Superior Mesenteric Artery Embolism
LI Shuangjing
YANG Yongqiang
Abstract：Objective To investigate the clinical characteristics,diagnosis and treatment,causes of misdiagnosis and preventive measures of acute superior mesenteric artery embolism(ASMAE).Methods The clinical data of 8 patients with ASAME misdiagnosed at early stage from January 2015 to January 2022 were retrospectively analyzed.Results There were 4 cases with a history of rheumatic heart valve and atrial fibrillation respectively.Two patients presented with upper middle ab-dominal pain,distension,diarrhea accompanied by nausea,vomiting,and fever in the middle and upper abdomen.Elevated levels of white blood cells,neutrophils,and hematuria amylase were detected.B-ultrasound examination of the abdomen showed slightly larger pancreas,which was misdiagnosed as acute pancreatitis.Two cases of epigastric dull pain accompanied by nausea,vomiting and diarrhea after eating irritating food were misdiagnosed as acute gastroenteritis.Two patients presented with upper abdominal pain,distension accompanied by nausea and vomiting.Abdominal X-ray examination showed mild intes-tinal dilation and multiple short gas-fluid levels,which was misdiagnosed as acute intestinal obstruction.Two patients presen-ted with right lower abdominal pain,diarrhea,accompanied by fever,vomiting,yellow watery stool,signs of peritoneal irrita-tion,elevated leukocytes and neutrophils,and were misdiagnosed as acute appendicitis.The duration of misdiagnosis was 17-23 h.Abdominal aortic CT angiography and exploratory laparotomy were used to confirm the diagnosis of SAME in all 8 cases.The necrotic bowel and mesentery were surgically removed and end-to-end intestinal anastomosis was performed.After opera-tion,they were given corresponding treatment,of whom 4 cases died,2 cases survived and 2 cases were lost to follow-up.Conclusion In the clinical treatment of patients with acute abdominal symptoms,if the symptoms are inconsistent with signs of severe abdominal pain,the medical history should be carefully inquired,the diagnostic thinking should be developed,SAME should be taken into consideration,and specific examination or even surgical exploration should be carried out as soon as possible for early diagnosis and treatment.
Keywords：Superior mesenteric artery embolismMisdiagnosisPancreatitisGastroenteritisIntestinal obstructionAppendicitisPeritoneal irritation signMedical history
Publication Date：2023-08-22
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 8-12 )