PARAMETERS DETERMINING THE OUTCOME OF PAT IENTS WITH BOWEL INFARCTIONDUE TO VASCULAR OCCLUSION

Despite diagnostic and therapeutic advances, mesenteric vascular occlu sion with intestinal infarction is often fatal. Parameters determining the high mortality are seldom discussed in the literature. By univari ate statistical analysis we correlated the therapeutic outcome of our patients to 20 parameters. Between 1 January 1984 and 30 April 1996 we treated 22 men and 18 women with acute bowel ischemia of vascular ori gin. All patients underwent laparotomy, 40% (n = 16) due to the diagno sis of mesenteric infarction. In 15% (n = 6) the laparotomy was only e xploratory; in 34 cases (85%) bowel resection was carried out. Mortali ty for all patients was 55% (n = 22). Univariate analysis of the 20 pa rameters showed that the therapeutic outcome was significantly correla ted to a pre-existing diabetes, the course of hospitalization, and the high ASA class. There was no correlation to the length of resected bo wel. Most parameters that determine the mortality of bowel infarction are pre-existing and cannot be influenced, but survival can be achieve d in some patients if radical and aggressive resection is carried out at the side of almost complete small bowel infarction and followed by an elective second-look operation. Even short-bowel syndrome can be tr eated. Patients can return to a near normal lifestyle with an acceptab le quality of life with the aid of parenteral nutrition at home.