Superior mesenteric artery embolism: eighty-two cases.

Eighty-two consecutive patients with superior mesenteric artery embolism were treated between 1966 and 1988. Abdominal pain was atypical or absent in 19 (23%) patients. Except for two instances of intraoperative embolism, emergency mesenteric arteriography was diagnostic in all cases. Seventeen patients were treated medically either because the site of embolism was peripheral, or because there were no life-threatening signs. Sixty-five patients underwent surgery, 31 for mesenteric infarction, and 34 for acute mesenteric ischemia without intestinal necrosis. Surgical treatment included 34 isolated embolectomies, 20 embolectomies associated with intestinal resection, two short segmental resections for limited necrosis of the small intestine, and nine exploratory laparotomies. Of the 34 patients operated on for acute mesenteric ischemia, 12 (35%) died. Of the 31 remaining patients operated on for intestinal infarction, 21 (68%) (p less than 0.05) died. The mean duration of ischemia before operation was 13 hours 20 +/- 6 min and 21 hours 24 +/- 24 min, respectively (p less than 0.05). Two patients (12%) receiving medical treatment died. This study confirms that survival is directly related to early diagnosis based on emergency mesenteric arteriography. Treatment is determined by clinical and roentgenographic criteria. Medical treatment is indicated in certain circumstances.