Abstract
A retrospective analysis of 121 patients (45 men; 76 women) suffering from mesenteric
ischemia was done to compare current diagnostic and therapeutic modalities. The average
age was 72.9 years and the overall mortality was 76%. In 45 patients (37%) only explorative
laparotomy was performed with none surviving, and 11 patients (9%) died before any
form of therapy could be undertaken. Twenty-six patients (21%) had bowel resection
alone (mortality: 62%): 8 also had preoperative thrombolytic therapy (38% mortality):
21 (17%) had bowel resection combined with a revascularization procedure with a mortality
of 48%; and 10 (8%) had revascularization alone (70% mortality). Significant findings
for mortality were duration of symptoms more than twelve hours, central mesenteric
occlusion with extensive intestinal infarction, stage of hypovolemic shock, and age.
Mean serum lactate concentration was 8.6 ± 2.8 mmol/L (normal 1.5 ± 1.0 mmol/L) at
onset, and level normalization following surgery was significant for an uncomplicated
recovery (p<0.001). Patients treated with primary anastomosis (63% mortality) did
poorer than those with a delayed anastomosis (47% mortality), but this was not significant
(p<0.1).
The authors conclude that high serum lactate concentration combined with abdominal
symptoms and leukocytosis in the absence of shock are highly suspicious indicators
of bowel ischemia and warrant surgery without delay. Surgery should combine revascularization
with extensive bowel resection. Postoperative monitoring of serum lactate seems to
obviate routine second-look operations in those with primary anastomosis.
