A Clinical Study on the Diagnosis and the Treatment of Mesenteric Arterial Occlusion Compared with Strangulation Ileus

Fumio Chikamori, Hiroyuki Aoyagi, Yasuhiro Takase*, Susumu Shibuya*, Niranjan Sharma*, Yoji Iwasaki*

Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital
*Department of Surgery, Institute of Clinical Medicine, University of Tsukuba

Twelve cases of mesenteric arterial occlusion were subjected to a clinical study to establish early diagnosis, and treatment modality. The results were compared with 27 cases of strangulation ileus for diagnosis, mode of treatment and prognosis. There was a significant difference (p<0.01) between mesenteric arterial occlusion and strangulation ileus for: the average age (69±9 vs. 54±21 years), history of laparotomy (17% vs. 74%), associated heart disease (75% vs. 22%), abdominal tenderness (58% vs. 96%), rebound tenderness (25% vs. 78%), muscle guarding (8% vs. 70%), elevated LDH (≥500 IU/l) (92% vs. 26%), massive bowel resection rate (70% vs. 11%), and mortality rate (50% vs. 4%), respectively. The massive bowel resection rate and mortality rate were higher in patients with mesenteric arterial occlusion than in those with strangulation ileus. Therefore, to make an early diagnosis and start treatment early, angiography should be performed in all elderly patients with ileus with heart disease, slight abdominal findings, LDH of ≥500 IU/l, and negative history of laparotomy.

Key words
mesenteric arterial occlusion, strangulation ileus, urokinase infusion, massive bowel resection

Reprint requests
Fumio Chikamori Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital
1-3-1 Amakubo, Tsukuba, 305 JAPAN

Accepted
January 8, 1992

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