Ds. Bryant et al., NONOCCLUSIVE INTESTINAL ISCHEMIA - IMPROVED OUTCOME WITH EARLY DIAGNOSIS AND THERAPY, The American surgeon, 63(4), 1997, pp. 334-337
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.