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Acute superior mesenteric ischaemia.

C Wilson, R Gupta, D G Gilmour

    The British Journal of Surgery
    |April 1, 1987
    PubMed
    Summary
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    Acute superior mesenteric ischaemia has a high mortality rate, with over half of cases diagnosed post-mortem. Early diagnosis and intervention, potentially aided by serum inorganic phosphate measurement and emergency angiography, are crucial for improving survival in this critical condition.

    Area of Science:

    • Vascular Surgery
    • Gastroenterology
    • Emergency Medicine

    Background:

    • Acute superior mesenteric ischaemia (SMI) is a critical condition with high mortality.
    • Diagnosis is often delayed, with a significant proportion of cases identified only during post-mortem examinations.
    • Current treatment strategies have shown limited impact on overall survival rates.

    Purpose of the Study:

    • To review patient records and post-mortem reports to assess outcomes for acute SMI.
    • To identify factors influencing survival and explore potential avenues for improving diagnosis and treatment.
    • To evaluate the impact of recent advancements in care on mortality.

    Main Methods:

    • Retrospective review of 102 patient case records and post-mortem reports from Glasgow Royal Infirmary over 12 years.

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  • Analysis of diagnostic timing, treatment modalities (exploratory laparotomy, bowel resection, revascularization), and survival rates.
  • Comparison of outcomes between patients diagnosed in life versus those diagnosed post-mortem.

    • Main Results:

    • Overall mortality for acute SMI was 92%; 53% of patients were diagnosed post-mortem.
    • Mortality was 84% for those diagnosed in life. Exploratory laparotomy alone had no survivors, while bowel resection alone had a 27% survival rate.
    • Revascularization procedures, often combined with resection, had a low survival rate (11%). Improvements in intensive care and revascularization use had minimal impact on mortality.

    Conclusions:

    • Delayed diagnosis and treatment are significant contributors to the poor outcomes in acute SMI.
    • Earlier diagnosis may be facilitated by measuring serum inorganic phosphate levels.
    • Widespread adoption of emergency angiography and revascularization procedures offers the most promising strategy for future survival improvements.