Intra-arterial thrombolytic therapy for acute mesenteric ischemia

We report a case of mesenteric ischemia secondary to embolic occlusion trea ted by percutaneous intra-arterial thrombolysis. Early initial radiographic evaluation included abdominal plain film, ultrasonography, abdominal CT, a nd arteriography. Only selective superior mesenteric artery angiography pro vided definite diagnosis. The duration of ischemic symptoms before thrombol ysis was 6 hours. Post procedure angiogram at 12 hours showed complete reso lution of the mesenteric arterial thrombus with clinical improvement. The m ost important criteria for patient survival is early diagnosis and immediat e treatment. Direct infusion of urokinase into the superior mesentric arter y may be an alternative to surgery in selected patients and particulary in patients without evidence of frank bowel necrosis.