Korean J Radiol.  2013 Feb;14(1):38-44. 10.3348/kjr.2013.14.1.38.

Mesenteric Vascular Occlusion: Comparison of Ancillary CT Findings between Arterial and Venous Occlusions and Independent CT Findings Suggesting Life-Threatening Events

• Wong YC
• Wu CH
• Wang LJ
• Chen HW
• Lin BC
• Huang CC

• KMID: 1430042
• DOI: http://doi.org/10.3348/kjr.2013.14.1.38

Abstract

OBJECTIVE
To compare the ancillary CT findings between superior mesenteric artery thromboembolism (SMAT) and superior mesenteric vein thrombosis (SMVT), and to determine the independent CT findings of life-threatening mesenteric occlusion.
MATERIALS AND METHODS
Our study was approved by the institution review board. We included 43 patients (21 SMAT and 22 SMVT between 1999 and 2008) of their median age of 60.0 years, and retrospectively analyzed their CT scans. Medical records were reviewed for demographics, management, surgical pathology diagnosis, and outcome. We compared CT findings between SMAT and SMVT groups. Multivariate analysis was conducted to determine the independent CT findings of life-threatening mesenteric occlusion.
RESULTS
Of 43 patients, 24 had life-threatening mesenteric occlusion. Death related to mesenteric occlusion was 32.6%. A thick bowel wall (p < 0.001), mesenteric edema (p < 0.001), and ascites (p = 0.009) were more frequently associated with SMVT, whereas diminished bowel enhancement (p = 0.003) and paralytic ileus (p = 0.039) were more frequent in SMAT. Diminished bowel enhancement (OR = 20; p = 0.007) and paralytic ileus (OR = 16; p = 0.033) were independent findings suggesting life-threatening mesenteric occlusion.
CONCLUSION
The ancillary CT findings occur with different frequencies in SMAT and SMVT. However, the independent findings indicating life-threatening mesenteric occlusion are diminished bowel wall enhancement and paralytic ileus.

Keyword

CT; Superior mesenteric artery thromboembolism; Superior mesenteric vein thrombosis; Life-threatening mesenteric occlusion; Independent finding

MeSH Terms

Arteries
Contrast Media/diagnostic use
Female
Humans
Iohexol/diagnostic use
Male
Mesenteric Vascular Occlusion/mortality/pathology/*radiography
Middle Aged
Multivariate Analysis
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed/*methods
Veins

Figure

• 

  Fig. 1 46 year-old male of nephrotic syndrome. CT scans shows acute superior mesenteric vein thrombosis (black arrow) with bowel wall thickening (white arrowhead), mesenteric edema (black arrowhead) and ascites. Note the normal SMA enhancement (white arrow) and ratio of SMV to SMA diameters > 2. He did not receive surgery but was treated with anticoagulation therapy. Follow-up CT showed abundant collateral veins and no bowel necrosis. SMA = superior mesenteric artery, SMV = superior mesenteric vein

• 

  Fig. 2 73 year-old female of atrial fibrillation and paralytic ileus. CT scan shows acute superior mesenteric artery occlusion (white arrow) with diminished enhancement of thin bowel walls (white arrowheads) as compared to normal duodenum (black arrowhead). Note normal SMV enhancement (black arrow) and ratio of SMV to SMA diameters of about 1. Extensive bowel gangrene was found at exploratory laparotomy. Bowel resection was not possible and she died of sepsis and acidosis. SMA = superior mesenteric artery, SMV = superior mesenteric vein

• 

  Fig. 3 Although the SMA orifice is normally enhanced, CT scans caudal to this level (not shown) reveal acute superior mesenteric artery occlusion. Note diminished enhancement of thin bowel walls (white arrowheads) as compared to normal duodenum (black arrowhead) and pneumatosis intestinalis (white arrows). Resection of small bowel and right colon showed coagulative necrosis. This 86 year-old female patient died of sepsis 4 days later. SMA = superior mesenteric artery

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