Mesenteric vascular occlusion resulting in intestinal necrosis in children

Purpose: The records of 4 patients who had necrotic bower secondary to acut e mesenteric vascular occlusion affecting various levels of mesenteric vasc ulature were reviewed to determine the clinical manifestations, diagnostic investigations, predisposing factors, complications, and outcome of mesente ric vascular thrombosis in children. Methods: The medical records of the patients (3 boys, 1 girl) treated betwe en 1981 and 1996, inclusive, for bowel infarction secondary to mesenteric v ascular thrombosis, were reviewed with regard to signs and symptoms, labora tory tests, radiological investigations, surgical findings, histopathologic examinations, and outcome. Results: The ages of the patients ranged between 1 and 14 yea rs with a mea n age of 8.2 years. Initial symptoms, present in ail patients, were abdomin al pain, abdominal distension, and tenderness, Laboratory and radiological findings including abdominal radiographs and abdominal ultrasonography were nondiagnostic. Selective superior mesenteric angiography showed complete o bliteration of the superior mesenteric artery with absence of venous return in 1 case. Three patients with massive intestinal necrosis died of multior gan failure or the complications of shot? bowel syndrome. Histological exam ination of the resected intestinal segments showed the typical findings of polyarteritis nodosa in 2 patients. One patient had a previous history of r ig ht femoral vein thrombosis, whereas 1 patient had no known underlying di sorders predisposing vascular thrombosis. Conclusions: Mesenteric vascular occlusion is a rare but serious disease le ading to death in children. The patients present with similar clinical sign s, most frequent and important are acute abdominal pain, vomiting, and dist ension. Mesenteric vascular occlusion is a rare cause of acute abdomen in c hildhood, which requires urgent diagnosis and intervention. in suspected me senteric vascular insufficiency, angiography should be performed followed b y intraarterial thrombolytic infusion therapy in selected cases. When intes tinal infarction is suspected, immediate surgical resection of compromised bowel is necessary with appropriate postoperative anticoagulation or treatm ent of a ny underlying disease. J Pediatr Surg 35,-1161-1164. Copyright (C) 2000 by W.B. Saunders Company.