[How can the prognosis of acute mesenteric artery ischemia be improved? Results of a retrospective analysis]

Abstract

Aim: Acute mesenteric ischemia is difficult to diagnose and is combined with a high mortality. In a retrospective analysis it was investigated how to improve the poor prognosis of the disease.

Patients and methods: Between January 1988 through December 1994 a total of 46 patients were operated on for acute mesenteric ischemia. Mesenteric artery occlusion was present in three quarters of the cases (n = 35). These were analysed according to symptoms, diagnosis, mechanism of occlusion, operative procedure and prognosis. Distribution of gender was almost balanced (19 women, 16 men) with a median age of 70.5 years.

Results: Embolic arterial occlusion was predominant (n = 22). Most frequently, the superior mesenteric artery was exclusively concerned (n = 22). Serum levels of lactate and leucocytes were preoperatively elevated in over 90% (median values: lactate 53 U/l, leucocytes 15050/ml). In 16 patients diagnosis was made on the ground of clinical parameters and/or angiography, but 19 patients were not diagnosed until operation. 19 patients were operated within 6 hours, 12 patients within 24 hours after admission (> 24 hours: n = 4). Vascular reconstructive procedures only, such as thrombectomy and/or aortomesenteric bypass were performed in 9 cases, in a further 7 cases combined with bowel resection. Bowel resection alone was done in 7 patients, 12 patients had only diagnostic laparotomy. 13 patients survived, 10 of them had been treated with vascular reconstruction.

Conclusion: Acute mesenteric ischemia ought to be suspected in every patient with uncertain abdominal pain, because only early diagnosis can improve prognosis. Measurement of serum lactate is diagnostically helpful, although not proving. In case of elevated lactate levels and uncertain abdominal symptoms angiography of the mesenteric vessels should be performed early. At operation, blood flow in the mesenteric arteries should be restored whenever possible.