[Diagnosis and prognosis of mesenterial infarct]

Abstract

Results: 28 cases of arterial thrombosis, 18 arterial embolism, 16 venous thrombosis and twelve cases of nonocclusive intestinal ischemia were diagnosed. History of symptoms on admission was longer in venous thrombosis (80 hours) than in arterial vascular occlusion (40 hours). There was a leukocytosis of 19.7/nl and lactate in serum was elevated in 85.1% of patients. Sonographic abdominal examination without preparation of the gut was normal in 44.6% (33/74 patients), variable distended loops of small intestine in the other cases. Sonographic measurement of mesenteric vascular flow succeeded only in 10.9%. Abdominal X-ray photography showed no characteristic signs in 21.6%. Variable degree of gaseous distension and fluid levels was described in 73.7%. Angiography was only performed in patients which were not supposed to be operated because of clinical examination (e.g. peritonitis). Eleven of 19 cases were diagnosed correctly (specificity 73.7%). Mortality rate of all patients was 70.3% and showed in further analysis significant differences in age, etiology of mesenteric ischemia, the length of ischemic and operatively resected gut.

Conclusion: If mesenteric vascular occlusion is suspected a quick diagnostic procedure and laparotomy for resection of gangrenous bowel is to be planned.