New aspects in the diagnosis and management of acute mesenteric infarction

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.