急性上腸間膜動脈閉塞症に対するウロキナーゼ動注療法　　２症例の報告

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  • Intraarterial Infusion of Urokinase for Acute Superior Mesenteric Artety Occlusion: A Report of Two Cases.

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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.

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