Abstract: Objective:To investigate the value of creatine kinase and computed tomography (CT) angiography to evaluate shortterm prognosis of patients with superior mesenteric artery embolism (SMAE).
Methods: The retrospective crosssectional study was adopted. The clinical data of 26 patients with SMAE who were admitted to the first Affiliated Hospital of Wenzhou Medical University between January 2008 and October 2015 were collected. The patients received serologic examination and CT angiography firstly, and then medicinal conservative method and surgical method were respectively conducted according to the results of above examinations. Observation indices: (1) clinical features, (2) serum indicators results, (3) CT angiography results: ① location (main stem and nonmain stem) of SMAE and development of distal branches of superior mesenteric artery (SMA), ② indirect signs, such as bowel wall thickening, bowel dilatation combined with effusion and air accumulation and pneumatosis intestinalis, (4) therapy and prognosis. Measurement data with normal distribution were presented as ±s, comparisons among groups were analyzed by oneway ANOVA. Measurement data with skewed distribution were presented as M (range) and analyzed by the KruskalWallis rank sum test, and pairwise comparison was done using the Nemenyi test.
Results:(1) Clinical features: of 26 patients with SMAE, 6 patients had intestinal ischemia, 8 patients had partial intestinal necrosis and 12 patients had long segmental intestinal necrosis (postoperative short bowel syndrome in 5 patients and total small intestinal necrosis and partial colonic necrosis in 7 patients). Duration of symptoms before diagnosis was (1.7±0.8)days in 6 patients with intestinal ischemia and (2.1±1.1)days in 8 patients with partial intestinal necrosis and (1.5±0.7)days in 12 patients with long segmental intestinal necrosis, with no statistically significant difference (F=1.27, P>0.05). (2) Serum indicators results: levels of serum creatine kinase in patients with intestinal ischemia, partial intestinal necrosis and long segmental intestinal necrosis were 68 U/L (range, 50-86 U/L), 98 U/L (range, 54-244 U/L) and 300 U/L (range, 40-873 U/L), respectively, with a statistically significant difference among patients (H=7.32, P<0.05) and between patients with intestinal ischemia and with long segmental intestinal necrosis (H=7.21, P<0.05), and with no statistically significant difference between patients with partial intestinal necrosis and with intestinal ischemia or long segmental intestinal necrosis (H=1.53, 2.07, P>0.05). (3) CT angiography results: ① developments of SMAE (main stem and nonmain stem) and distal branches of SMA: main stem embolism of SMA in 13 patients demonstrated hypodense shadow, with noncontrast of distal branches of artery, including 1 with intestinal ischemia, 1 with partial intestinal necrosis and 11 with long segmental intestinal necrosis. Main stem embolism of SMA in 8 patients demonstrated hypodense shadow, with contrast of distal branches of SMA, including 3 with intestinal ischemia, 4 with partial intestinal necrosis and 1 with long segmental intestinal necrosis. Main stem embolism of SMA in 2 patients demonstrated hypodense shadow, with noncontrast of distal branches of SMA, showing partial intestinal necrosis. Nonmain stem embolism of SMA in 3 patients demonstrated hypodense shadow, with contrast of distal branches of SMA, including 2 with intestinal ischemia and 1 with partial intestinal necrosis. ② Indirect signs: 5 patients had bowel wall thickening, including 3 with intestinal ischemia and 2 with long segmental intestinal necrosis. Seventeen patients had bowel dilatation combined with effusion and air accumulation, with gas fluid level in local intestinal canal, including 2 with intestinal ischemia, 5 with partial intestinal necrosis and 10 with long segmental intestinal necrosis. Two patients had pneumatosis intestinalis, with bubble shadow of bowel wall, showing long segmental intestinal necrosis. (4) Therapy and prognosis: of 6 patients with intestinal ischemia, 1 underwent embolectomy of SMA and 5 underwent lowmolecularweight heparin anticoagulation and vasodilator alprostadil therapy. Eight patients with partial intestinal necrosis received resection of necrotic intestine. Of 12 patients with long segmental intestinal necrosis, 5 with postoperative short bowel syndrome received resection of necrotic intestine combined with postoperative parenteral hyperalimentation. The abovementioned patients were improved and discharged from hospital after symptomatic treatment and surgery. Twelve patients with long segmental intestinal necrosis, 7 with total small bowel necrosis and partial colonic necrosis underwent only exploratory laparotomy and then were dead in a short time.
Conclusion:Elevated creatine kinase and main stem embolism of SMA combined with noncontrast of distal branches using CT angiography maybe predict poor shortterm prognosis of patients with SMAE.