Intestinal ischemia associated with cardio-pulmonary-bypass surgery: a life threatening complication

Intestinal ischemia following open heart surgery is rare but nevertheless extremely dangerous and the causes are still unclear. The purpose of this study was to evaluate the factors influencing the occurrence and outcome of patients with this complication. At our institution between 1985 and 1989 1712 patients underwent open heart surgery and 4 female patients suffered from intestinal ischemia. The early mortality was 2.5% for the whole group and 100% for the group with intestinal ischemia. All these 4 patients were elderly and had a history of hypertension and hyperlipoproteinemia. Three of the four patients with intestinal ischemia had various risk factors for thromboembolic events such as pre-existing occlusive arterial disease and cardiac dysrhythmias or had a complicated postoperative course. In two patients an enormous increase in serum lactate to over 10 mmol/l occurred prior to the intestinal ischemia. We therefore consider advancing age, female gender and a susceptibility for thromboembolic events as important risk factors for the development of intestinal ischemia. A serum lactate over 10 mmol/l should lead to an aggressive diagnostic and therapeutic approach including exploratory laparotomy.