Usefulness and Safety of Simultaneous Anastomosis at Bowel Resection for Acute Mesenteric Arterial Occlusion in Elderly Patients

Yoshihiro Moriwaki, Noriyuki Kamiya, Mitsunobu Kikuchi, Yukihiro Ozawa, Mitsugi Sugiyama, Hirohumi Harada^*, Chikara Kunisaki^*, Sinsuke Imai^*, Syunsuke Kobayashi^* and Chitaka Kasaoka^*

Department of Critical Care and Emergency Medicine, Yokohama City University,
School of Medicine, Urafune-Hospital^*Department of Surgery, Fujisawa Municipal Hospital

We reptort the usefulness and the safety of simultaneous mechanical anastomosis by metallic stapler at massive small bowel resection for senile acute mesenteric arterial occlusion in elderly patients. Three female patients, aged 83, 78, and 75 years old. were diagnosed as acute mesenteric arterial occlusion and underwent massive small bowel resection. Bowel necrosis and bloody peritoneal fluid was noted without bowel perforation. Simultaneous anastomosis by metallic stapler was performed without any strong intention to preserve small bowel as long as possible because of their age. In the two first cases side-to-end anastomosis was performed and the other case end-to-side. Remnant small bowel was 30 cm from the ligament of Treitz. 50 cm from the pyloric ring and 30 cm from the ligament of Treitz, respectively. Postoperative oral feeding was started at postoperative days 16, 17 and 10, respectively. The frequency of defectation was 3∼4, 0∼1 and 15 times a day, respectively. The patient undergoing end-to-side anastomosis had a high frequency of defecation. The volume of infusion required was 2,000ml, 1,000ml and 1,000∼2,000ml a day, respectively. No signs of anastomotic leakage or progressive ischemia in the remnant small bowel were seen in the postoperative course of all 3 cases. The disadvantages with provximal jejunostomy were avoided by simultaneous reconstruction. Postoperative jejunography showed the benefit of side-to-end anastomosis in regard to absorption.

Key words
acute mesenteric arterial occlusion, elderly patients

Reprint requests
Yoshihiro Moriwaki Department of Critical Care and Emergency Medicine, Yokohama City University, School of Medicine, Urafune Hospital 3-46 Urafune-cho, Minami-ku, Yokohama-City, 232-0024 JAPAN

Accepted
March 31, 1999

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