Clinical Study of Acute Mesenteric Ischemia

Yasushi Morita, Yasutomo Azumi and Mitsuharu Nakamoto

Department of Surgery, Hyogo Brain and Heart Center at Himeji

Background: Diagnosis and treatment of acute mesenteric ischemia (AMI) is difficult and often delayed, resulting in irreversible bowel injury that easily develops into multiple organ failure involving high mortality. Materials and Methods: We clinically analyzed patients who underwent surgery for AMI. To determine prognostic factors in the disease, we compared clinical factors between a group of 20 survivors and a group of 29 nonsurvivors. Results: Postoperative survival was 41%. Mean age was 70.7 years (male:female: 33:16). Associated cardiovascular disease was found in 94% of patients, 76% of whom had undergone cardiovascular surgery. Of the 27% were preoperatively diagnosed with AMI confirmed by and abdominal angiography. Where AMI occurred after ischemic heart disease or acute aortic dissection, mortality was higer. Differences were significant in perioperative serum LDH, GPT, Cre, and base excess levels between the groups. Higher mortality was observed among patients with bowel injury to both superior and inferior mesenteric arteries (2 branches) than among those with injury to 1 branch. Although the time from onset to surgery, surgical procedures and postoperative Ca-antagonist infusion did not affect prognosis, postoperative heparinization significantly improved it. Conclusions: In previous illness, liver and renal dysfunction, the extent of vascular disorder in bowel ischemia, and postoperative metabolic acidosis may be candidate predictors for AMI prognosis. Angiography may be useful in early diagnosis, and beginning treatment before the occurrence of multiple organ dysfunction is crucial. Complete resection of ischemic lesions and heparinization could prevent postoperative continuation and recurrence of mesenteric ischemia, improving AMI prognosis.

Key words
mesenteric ischemia, bowel infarction, prognosis

Reprint requests
Mitsuharu Nakamoto Department of Surgery, Hyogo Brain and Heart Center at Himeji
520 Saisho-kou, Himeji, 670-0981 JAPAN

Accepted
November 30, 2004

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