Mesenteric ischaemia: prognostic factors and influence of delay upon outcome

The case records of 43 patients with acute mesenteric ischaemia who presented to the Professorial Surgical Unit, Aberdeen Royal Infirmary between January 1982 and December 1992 were examined. Principal presenting clinical symptoms were acute abdominal pain (100%) with diarrhoea in 44% of patients. Abdominal examination revealed diffuse non-specific tenderness in 48%, with signs of peritonitis in 52% of patients. In 22 of the 43 (51%) patients there was a delay in diagnosis (greater than 12 h from the onset of pain). The overall mortality was 70%, and three significant prognostic factors were identified--surviving patients had a delay in diagnosis of less than 12 h, a normal chest radiograph and a higher arterial paO2, (10.0 +/- 1.0 vs 7.7 +/- 1.2, P < 0.05, vs non-survivors), on admission to the surgical unit. Twenty-five of the 29 non-surviving patients had extensive infarction of small and large intestine, compared with only 1 of the 14 surviving patients (P < 0.05).