Diagnostic Pitfalls at Admission in Patients with Acute Superior Mesenteric Artery Occlusion.
Acosta, Stefan LU
; Block, Tomas
; Björnsson, Steinarr
LU
; Resch, Timothy
; Björck, Martin
and Nilsson, Torbjörn
(2012)
In Journal of Emergency Medicine
42(6).
p.635-641
- Abstract
- BACKGROUND: Acute superior mesenteric artery (SMA) occlusion leads to acute intestinal ischemia and is associated with high mortality. Early diagnosis is often missed, and confounding factors leading to diagnostic delays need to be highlighted. OBJECTIVES: To identify potential diagnostic laboratory pitfalls at admission in patients with acute SMA occlusion. METHODS: Fifty-five patients with acute SMA occlusion were identified from the in-hospital register during a 4-year period, 2005-2009. RESULTS: The median age was 76 years; 78% were women. The occlusion was embolic in 53% and thrombotic in 47% of patients. At admission, troponin I was above the clinical decision level (> 0.06 μg/L) for acute ischemic myocardial injury in 9/19 (47%)... (More)
- BACKGROUND: Acute superior mesenteric artery (SMA) occlusion leads to acute intestinal ischemia and is associated with high mortality. Early diagnosis is often missed, and confounding factors leading to diagnostic delays need to be highlighted. OBJECTIVES: To identify potential diagnostic laboratory pitfalls at admission in patients with acute SMA occlusion. METHODS: Fifty-five patients with acute SMA occlusion were identified from the in-hospital register during a 4-year period, 2005-2009. RESULTS: The median age was 76 years; 78% were women. The occlusion was embolic in 53% and thrombotic in 47% of patients. At admission, troponin I was above the clinical decision level (> 0.06 μg/L) for acute ischemic myocardial injury in 9/19 (47%) patients with embolic occlusion. Elevated pancreas amylase and normal plasma lactate were found in 12/45 and 13/27, respectively. A troponin I (TnI) above the clinical decision level was associated with a high frequency of referrals from the general surgeon to a specialist in internal medicine (p = 0.011) or a cardiologist (p = 0.024). The diagnosis was established after computed tomography angiography in 98% of the patients. The overall in-hospital mortality rate was 33%. Attempting intestinal revascularization (n = 43; p < 0.001), with a 95% frequency rate of completion control of the vascular procedure, was associated with a higher survival rate, whereas referral to the cardiologist was associated with a higher mortality rate (p = 0.018). CONCLUSION: Elevated TnI was common in acute SMA occlusion, and referral to the cardiologist was found to be associated with adverse outcome. Elevated pancreas amylase and normal plasma lactate values are also potential pitfalls at admission in patients with acute SMA occlusion. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/2274620
- author
- Acosta, Stefan
LU
; Block, Tomas
; Björnsson, Steinarr
LU
; Resch, Timothy
; Björck, Martin
and Nilsson, Torbjörn
- organization
- publishing date
- 2012
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Emergency Medicine
- volume
- 42
- issue
- 6
- pages
- 635 - 641
- publisher
- Elsevier
- external identifiers
-
- wos:000305591000002
- pmid:22137151
- scopus:84862197651
- ISSN
- 1090-1280
- DOI
- 10.1016/j.jemermed.2011.03.036
- language
- English
- LU publication?
- yes
- id
- 2beddfb7-5c7d-407a-affa-32eb70bafde4 (old id 2274620)
- alternative location
- http://www.ncbi.nlm.nih.gov/pubmed/22137151?dopt=Abstract
- date added to LUP
- 2016-04-04 07:31:02
- date last changed
- 2022-02-28 03:40:45
@article{2beddfb7-5c7d-407a-affa-32eb70bafde4,
abstract = {{BACKGROUND: Acute superior mesenteric artery (SMA) occlusion leads to acute intestinal ischemia and is associated with high mortality. Early diagnosis is often missed, and confounding factors leading to diagnostic delays need to be highlighted. OBJECTIVES: To identify potential diagnostic laboratory pitfalls at admission in patients with acute SMA occlusion. METHODS: Fifty-five patients with acute SMA occlusion were identified from the in-hospital register during a 4-year period, 2005-2009. RESULTS: The median age was 76 years; 78% were women. The occlusion was embolic in 53% and thrombotic in 47% of patients. At admission, troponin I was above the clinical decision level (> 0.06 μg/L) for acute ischemic myocardial injury in 9/19 (47%) patients with embolic occlusion. Elevated pancreas amylase and normal plasma lactate were found in 12/45 and 13/27, respectively. A troponin I (TnI) above the clinical decision level was associated with a high frequency of referrals from the general surgeon to a specialist in internal medicine (p = 0.011) or a cardiologist (p = 0.024). The diagnosis was established after computed tomography angiography in 98% of the patients. The overall in-hospital mortality rate was 33%. Attempting intestinal revascularization (n = 43; p < 0.001), with a 95% frequency rate of completion control of the vascular procedure, was associated with a higher survival rate, whereas referral to the cardiologist was associated with a higher mortality rate (p = 0.018). CONCLUSION: Elevated TnI was common in acute SMA occlusion, and referral to the cardiologist was found to be associated with adverse outcome. Elevated pancreas amylase and normal plasma lactate values are also potential pitfalls at admission in patients with acute SMA occlusion.}},
author = {{Acosta, Stefan and Block, Tomas and Björnsson, Steinarr and Resch, Timothy and Björck, Martin and Nilsson, Torbjörn}},
issn = {{1090-1280}},
language = {{eng}},
number = {{6}},
pages = {{635--641}},
publisher = {{Elsevier}},
series = {{Journal of Emergency Medicine}},
title = {{Diagnostic Pitfalls at Admission in Patients with Acute Superior Mesenteric Artery Occlusion.}},
url = {{http://dx.doi.org/10.1016/j.jemermed.2011.03.036}},
doi = {{10.1016/j.jemermed.2011.03.036}},
volume = {{42}},
year = {{2012}},
}