ACUTE MESENTERIC ISCHEMIA

Acute mesenteric Ischemia is a life-threatening vascular emergency. A retrospective analysis of our patients was performed to describe the d evelopment of the various procedures of diagnostic assessment and trea tment between 1970 and 1996, to show the influence on survival and to define recent standards. Patients: Between 1970 and 1996, 145 patients , 75 male and 70 female, suffering from acute mesenteric ischemia, hav e been treated at the Department of Surgery-University Hospital Vienna . Results: In most cases AMI was caused by arterial embolism (64.1%, n = 93) followed by arterial thrombosis (27.6%, n = 40). Venous thrombo sis (3.5%, n = 5) and nonocclusive AMI (4.8%, n = 7) were rare events. Serum lactate level has been determined routinely in all patients hav ing been admitted with acute abdomen since 1984 and turned out to be p ositive in 81.2% (mean value 9.81 (3.21-22.3) mmol/l). Abdominal x-ray gave only in some individual cases special hints to the advanced inte stinal gangrene. Abdominal sonography led to the correct diagnostic as sessment in 52 patients (= 35.8%). Angiography was in 92% conclusive f or the diagnosis. Abdominal CT led to establish the correct diagnosis in >80%. Our series with revascularisation (thrombectomy/embolectomy o r bypass) has resulted in 73.8% patient survival with intestine having been maintained in the most favourable cases. Conclusions: Early diag nostic assessment and treatment are decisive for survival. Abdominal-C T, angiography and serumlactate constitute quick and reliable means to provide diagnosis and to judge the stage of AMI in addition to meticu lous examination of patients' history, symptoms and physical condition s.