1Department of Surgery, Yanagi Hospital, 2Surgery, Kobayashi Municipal Hospital, 3Surgery, National Hospital Organization Kumamoto Medical Center
OBJECT: Acute mesenteric ischemia（AMI）is morbid condition associated with high mortality. To rescue the patients of AMI, prompt recognition and decision of proper laparotomy before ischemia progress to necrosis is crucial. Recently doctors tend to rely on multi-detector computed tomography（MDCT）and even to skip the procedure of US. The aim of this paper is to estimate the AMI as vascular emergency and reexamine the potential of US by applying contrast enhanced study（CEUS）for the diagnosis of AMI. 【METHOD】 Forty one patients of acute abdominal patients were enrolled. First, B-mode US（3.75-7.5MHz）of the entire abdomen was performed to detect 1: presence /absence of arterial SMA flow, presence/absence of bowel wall thickening（≧3mm）, presence /absence of“to and fro sign”, presence/absence of fluid collection. While visualizing the lesion, second-generation contrast agent consisting of perflubutane microbubbles was administered as a bolus intravenous injection. This study was approved by the committee of institute. Informed consent was obtained from patients enrolled in this study. RESULT: CEUS was performed for 41 patients. The final diagnosis were strangulated bowel obstruction10/41, non-obstructive mesenteric ischemia（NOMI）7/41, postoperative, impaction of inguinal hernia4/41 mechanical ileus4/41, inflammatory bowel disease3/41, ventral hernia3/41, superior mesenteric artery obstruction2/41, enteromerocele2/41, obtulator hernia1/41, ischemic bowel desease2/41, mesenteric venous thrombosis1/41, and unknown origin2/41. CEUS for AMI showed 4 patterns. （1: diffuse enhancement, 2: circular enhancement, 3: multiple spotted absent, 4: complete absent, 5: diffuse enhancement with stagnation of contrast material）Patterns of P3, P4 and P5 assumed to be a sign of bowel ischemia necessary for laparotomy or even enterectomy. 【CONCLUSIONS】 Even the recent diffusion of MDCT for AMI, there are some disadvantages with this modality such as nephrotoxicity with contrast agent. The advantage of CEUS with perflubutane gas is to enable real time visualization of vascularity of bowel wall with less invasion.