IMPROVED OUTCOME BY IDENTIFICATION OF HIGH-RISK NONOCCLUSIVE MESENTERIC ISCHEMIA, AGGRESSIVE REEXPLORATION, AND DELAYED ANASTOMOSIS

BACKGROUND: The factors associated with outcome of patients with nonoc clusive mesenteric ischemia are poorly defined. METHODS: Over a 7-year period, 34 consecutive patients with nonocclusive mesenteric ischemia were identified. RESULTS: The mean age of the study patients was 63 y ears (range 31 to 94); 21 of 34 (62%) were men. The mean delay in diag nosis was 31 hours (range 7 hours to 6 days), Seven of 34 (21%) underw ent preoperative visceral arteriography. Two of these 7 required surge ry, and both died as a result of intestinal infarction. The remaining 27 had the diagnosis made at celiotomy, Among the 29 who were explored , 16 of 29 (55%) had intestinal infarction. Twenty-one of 29 (72%) had segmental bowel injury whereas 8 of 29 (28%) had massive injury. Amon g those with segmental infarction, primary anastomosis was performed i n 12 of 21 patients (57%); 5 of the 12 (42%) died. Nine of 21 patients (43%) underwent delayed anastomosis; 2 of the 9 (22%) died. No patien t with massive injury underwent primary anastomosis. Second-look lapar otomy was performed on 22 of 29 (76%). Eleven of those 22 (50%) had a further bowel resection. Overall, 16 of 29 (55%) who underwent surgery for nonocclusive mesenteric ischemia are alive. CONCLUSIONS: Improved survival from nonocclusive mesenteric ischemia is dependent upon the identification of high-risk groups, aggressive re-exploration, and del ayed intestinal anastomosis.