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Treatment of mesenteric infarction.
The British Journal of Surgery
|June 1, 1987
Summary
Mesenteric infarction has high mortality. New treatment strategies focusing on preventing ischemia and reperfusion injury, including angiography with vasodilators and anticoagulation, are proposed to reduce recurrence and improve survival.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Critical Care Medicine
Background:
- Mesenteric infarction presents a significant challenge due to persistently high mortality rates.
- Understanding the causes of early recurrence is crucial for improving patient outcomes.
Purpose of the Study:
- To review cases of mesenteric infarction to identify factors contributing to high mortality.
- To propose enhanced treatment strategies to mitigate recurrent ischemia and reperfusion injury.
Main Methods:
- Retrospective review of 81 cases of mesenteric infarction diagnosed via angiography, laparotomy, or autopsy.
- Analysis of patient outcomes based on treatment modality: supportive care versus surgical intervention (bowel resection/revascularization).
Main Results:
- 46% of patients received supportive care for inoperable lesions; 54% underwent surgical intervention.
- Among surgically treated patients, 45% survived, 32% died from early recurrence, and 23% died from unrelated causes.
- A high rate of early postoperative recurrence was observed, highlighting the need for improved management.
Conclusions:
- Persistent or recurrent ischemia, including vasoconstriction and reperfusion tissue damage, drives high mortality in mesenteric infarction.
- Suggested treatment enhancements include routine angiography with selective vasodilator perfusion, pre-operative pharmacological protection against ischemic/reperfusion damage, and post-operative anticoagulation.