NONOCCLUSIVE INTESTINAL ISCHEMIA - IMPROVED OUTCOME WITH EARLY DIAGNOSIS AND THERAPY

Nonocclusive intestinal infarction (NOII) is described as bowel necros is at celiotomy or autopsy without evidence of thromboembolism, vascul itis, or mechanical obstruction. The mortality for this entity is as h igh as 90 per cent in some series. From January 1990 to January 1995, we identified 15 patients who met the criteria for NOII identified at celiotomy or autopsy. We collected data on demographics, comorbidities , presenting signs and symptoms, laboratory workup, time to definitive therapy, and outcome. Our goal was to improve our ability to identify and treat this devastating surgical problem. There was a 4.5:1 female to male ratio, and patients had an average age of 73 +/- 10 years. Si gnificant comorbidities included coronary artery disease (87%) and atr ial fibrillation (73%). Eleven patients were diagnosed at celiotomy an d four at autopsy. Overall mortality was 67 per cent. The most common presenting symptoms were abdominal pain (93%) and distention (80%) and mental status changes (60%). Peritonitis was less common, present in only 40 per cent of the patients. Leukocytosis, bandemia, increased cr eatinine, metabolic acidosis, and hypoxemia were common among all pati ents. There was a significant difference in time to definitive therapy in survivors versus nonsurvivors (1.2 +/- 0.89 vs 4.8 +/- 2.0 days; P < 0.02, t test). These data suggest that NOII is a lethal surgical pr oblem. A history of coronary artery disease and atrial fibrillation wa s common among all patients. Various nonspecific presenting signs, sym ptoms, and laboratory values are suggestive of this diagnosis. A high index of suspicion in select patients and early intervention may lead to improved outcome.