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Acute mesenteric embolism: an appeal for a pro-active diagnostic approach
W K de Roos1, R H Geelkerken, J H van Bockel
1Department of Vascular Surgery, Academic Hospital, State University, Leiden, The Netherlands.
The Netherlands Journal of Surgery
|August 1, 1990
Summary
A proactive approach to acute mesenteric embolism, involving emergency angiography and surgery, improves patient survival and bowel function. This strategy aids in early diagnosis and treatment, reducing mortality from intestinal infarction.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Emergency Medicine
Background:
- Acute mesenteric ischemia, often caused by arterial embolism, presents with non-specific symptoms leading to delayed diagnosis.
- Late recognition of acute mesenteric ischemia frequently results in intestinal infarction and peritonitis, conditions associated with high mortality rates.
Purpose of the Study:
- To evaluate the efficacy of a proactive management strategy for acute mesenteric embolism.
- To assess the impact of early diagnosis and surgical intervention on patient survival and gastrointestinal function.
Main Methods:
- Implementation of a proactive approach since 1982, including emergency angiography and/or laparotomy for patients with severe acute abdominal complaints after excluding other causes.
- Primary vascular reconstructive surgery was performed when feasible following diagnosis confirmation.
- Treatment of eight patients with acute mesenteric embolism using this policy.
Main Results:
- Three out of eight patients died from extensive intestinal infarction during the perioperative period.
- Five surviving patients demonstrated normal diet tolerance and bowel function upon hospital discharge.
- The proactive strategy led to successful outcomes in 62.5% of treated patients.
Conclusions:
- A proactive management strategy for acute mesenteric embolism, characterized by early diagnostic interventions and surgical repair, can significantly improve survival rates.
- This approach helps preserve a normally functioning alimentary tract, mitigating long-term complications associated with intestinal infarction.