HOW CAN PROGNOSIS OF ACUTE MESENTERIC ISC HEMIA BE IMPROVED - RESULTSOF A RETROSPECTIVE ANALYSIS

Aim: Acute mesenteric ischemia is difficult to diagnose and is combine d with a high mortality. In a retrospective analysis it was investigat ed how to improve the poor prognosis of the disease. Patients and Meth ods: Between January 1988 through December 1994 a total of 46 patients were operated on for acute mesenteric ischemia. Mesenteric artery occ lusion was present in three quarters of the cases (n = 35). These were analysed according to symptoms, diagnosis, mechanism of occlusion, op erative procedure and prognosis. Distribution of gender was almost bal anced (19 women, 16 men) with a median age of 70.5 years. Results Embo lic arterial occlusion was predominant (n = 22). Most frequently, the superior mesenteric artery was exclusively concerned (n = 22). Serum l evels of lactate and leucocytes were preoperatively elevated in over 9 0 % (median values: lactate 53 U/I, leucocytes 15050/ml). In 16 patien ts diagnosis was made on the ground of clinical parameters and/or angi ography, but 19 patients were not diagnosed until operation. 19 patien ts were operated within 6 hours, 12 patients within 24 hours after adm ission (> 24 hours: n = 4). Vascular reconstructive procedures only, s uch as thrombectomy and/or aortomesenteric bypass were performed in 9 cases, in a further 7 cases combined with bowel resection. Bowel resec tion alone was done in 7 patients, 12 patients had only diagnostic lap arotomy. 13 patients survived, 10 of them had been treated with vascul ar reconstruction. Conclusion: Acute mesenteric ischemia ought to be s uspected 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 lac tate levels and uncertain abdominal symptoms angiography of the mesent eric vessels should be performed early. At operation, blood flow in th e mesenteric arteries should be restored whenever possible.