[Surgical tactics in acute mesenteric artery occlusion]

Abstract

Operations were performed on 52 patients for acute mesenteric embolism, between 1980 and 1988. The average age of 48 of them was 75.8 +/- 7.3 years. Only four patients were below 60 years of age. Only exploratory laparotomy was possible in 20 cases, and all of these patients died. Six of eight patients (75 per cent) did not survive embolectomy from the superior mesenteric artery. Seven of twelve patients (58 per of eleven patients (27 per cent) died after embolectomy and resection of subtotal parts of the small intestine. Death occurred also to one patient with acute iliaco-mesenteric bypass. Hence, total mortality of all 52 patients amounted to 71.1 per cent. The mortality rate for 32 patients with attempted restitutional surgery amounted to 53.1 per cent, exploratory laparotomy unconsidered. This was certainly attributable to 73 per cent of survivors of embolectomy combined with removal of somewhat extended intestinal sections. Follow-up checks in short intervals of serum lactate have proved to provide reliable diagnostic parameters and means for postoperative appraisal with a view to making an informed estimate of changes of a second-look operation for acute intestinal ischaemia. The lactate mean value for mesenteric embolism was 8.88 +/- 4.43 mmol/l. However, lactate values were normal, between 1 mmol/l and 2 mmol/l, in acute abdominal processes with non-ischaemic causes and in cases of ischaemia of extremities.(ABSTRACT TRUNCATED AT 250 WORDS)