MULTIPLE ORGAN DYSFUNCTION AFTER MESENTERIC-ARTERY REVASCULARIZATION

Purpose: Mesenteric arterial reconstruction in patients with acute or chronic intestinal ischemia is associated with significant morbidity a nd mortality rates. Reperfusion of ischemic bowel in animals leads to release of multiple factors that cause organ dysfunction. Similar phen omena potentially occur in human beings after repair of symptomatic ch ronic mesenteric arterial disease. The purpose of this study was to de fine the incidence of multiple organ dysfunction seen after reperfusio n of the chronically ischemic bowel. Method: Between January 1990 and january 1993, 18 patients underwent surgical revascularization for sym ptomatic chronic mesenteric arterial occlusive disease. Four patients required emergency surgery, whereas 14 procedures were done electively . Hepatic, renal, pulmonary, and coagulation function were evaluated i n atl patients. Bypass graft patency was confirmed by duplex scanning or repeat operation in all patients with deteriorating conditions. Res ults. Immediately after surgery hepatic function deteriorated. The ser um transaminases increased 90- to 100-fold whereas lactate dehydrogena se increased 25-fold. Simultaneously, platelet counts dropped below 40 ,000 mm3 in 11 patients. On postoperative day 2, 16 patients had acute pulmonary insufficiency demonstrated by an increase in the pulmonary shunt fraction to a mean of 32% +/- 3% (range 21% to 60%). Ten patient s required reintubation, and lung failure lasted an average of 8.4 day s (range 1 to 35 days). Hepatic and coagulation function changes were usually transient, returning to baseline within 7 to 10 days. Four of the patients who had multiple organ dysfunction died (two after electi ve surgery), and one patient died of myocardial infarction after emerg ency surgery. Conclusion: Revascularization of chronically ischemic bo wel leads to significant multiple organ dysfunction, potentially as a result of intestinal ischemia and reperfusion injury.