[Surgical therapy of mesenteric infarct]

Abstract

Acute mesenteric infarction represents less than 1-2% of all surgical emergencies but is responsible for many lethal events. A successful management requires very efficient diagnostic and therapeutic measures. Cases with established bowel infarction are associated with a mortality rate of 80-90% since years. In the last 10 years some hospitals offering an aggressive pre-, per- and postoperative multimodal therapy could reduce the mortality in selected series to 50-60%. One of the most important factors to reduce the mortality is beneath early diagnosis the emergency angiography and the angiography-associated treatment like intraarterial application of vasodilators, even in occlusive forms of mesenteric infarction. But this concept is seldom applicable to small hospitals because of the partially lacking availability of angiography. We present a concept of treatment taking into account this fact. Generous indication for emergency laparotomy in patients suspect of acute mesenteric ischemia is the central pillar of our concept. We also plea for a very restraint indication in biologically old multimorbid patients presenting a sum of negative prognostic factors and consider in these cases the reluctant attitude as an ethically and medically positive behaviour.