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1、CaseDiscussion:AcuteMesentericIschemiaRi柯雅琳2008/02/18Pasthistory61y/omanPastmedicalhistory:DCM,LVEF22%,4-chamberdilatationAfibDMnotedfor3yearsCADs/pPTCAPAODs/psequestrectomy&STSGPersonalhabits:Alcohol:2glassesof高粱perdaySmoking:0.5PPDfor40yrs,quittedf

2、or7-8yrChiefcomplaint2008/01/18:SuddenonsetleftarmpainOPD:leftbrachialarterythromboembolism2008/01/1820:30Emergentembolectomyoftheleftbrachialartery2x1cm3x1cmPost-opradialpulsation(+);warmthofthelefthand(+)Post-OPCourse2008/01/1909:30Acuteonsetepigas

3、tralgiaPESoft,noreboundingpainBS:Hyperactive,nometallicsoundHxofeatingcontaminatedfood?(吃前晚便當做早餐)Post-OPCourse2008/01/1910:53Nausea(+),vomitingx1(foodcontent)PE:Soft,BS:normoactive,tympanicreboundingpain(-),McBourneypointtenderness(-),psoassign(-)

4、LabCK54CK-MB19Post-OPCourse2008/01/1912:20:EmergentabdominalCTSMAocclusionEndovascularEmbolectomy:2008/01/1913:30-19:50RFArouteSMAocclusion,5cmfromorigin,about5cminlength.PoordistalflowSeverestenosis,unabletopasstheguidewireThrombosuction:alsofailed

5、ExplainedtothefamilyArrangelaparotomySegmentalmucosalnecrosisofthesmallintestine5cmdarkredembolismat5cmdistaltotheoriginofSMA2ndLaparatomy2008/01/2108:00Tube-duodenostomyTube-ileostomyR/Dindouglaspouch,areabelowT-colonnearTreitzligmentTube-duodenost

6、omyTube-ileostomy-Gangrenouschange&partialnecrosisfromTreitzligmentto30cmaboveileocecalvalve-MuchbloodclotsinperitonealcavityOPday(21)POD1(22)POD2(23)POD3(24)POD4(25)POD5(26)POD6(27)FeverFlumarinMetronidazoleDopamineWBC15.63KCRP21.86AgitationHeadCT:

7、nofocallesionWBC9.19KCre3.1T-Bil3.6Sputumculture(-)IAP:22cmH2OL’tR/D:Amy5910Lip4690LDH17353L’tR/D:Amy11194Lip16700LDH18951CRP11.29↓WBC9.52K↑BilT/D11.2/9.46NG/duodeostomy↓Cre2.1WBC11.91K↑BilT/D14.77/11.39CordaronDigoxin0.125mgCallVSIleostomy

8、feeding(D5W)DNRNG1120Duodenum635NG1120L’tR/D104GR’tR/D100GDuodenum638ileum17POD7(28)POD8(29)POD9(30)POD10(31)POD11(1)POD12(2)POD13(3)FlumarinRMetronidazoleSMaxipimeSSPenicillinGNG150L’tR/D55R’tR/D1060Duodenum10ileum0TBil10.42W’d/CE.cloa