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Acute mesenteric ischemia following cardiac surgery
J Klempnauer1, F Grothues, H Bektas
1Department of Abdominal and Transplantation Surgery, Medical School Hannover, Germany.
Background:
The results of surgical intervention for acute mesenteric ischemia following major cardiac surgery were analysed.
Experimental Design:
Retrospective investigation. Setting. University Hospital of Hannover Medical School.
Patients:
Eleven patients (five women and six men) amongst a total of 90 patients operated from 1972 to 1993 because of an acute splanchnic ischemia. This subgroup represented 12%. The causes of splanchnic ischemia were arterial embolism in 55% and nonocclusive disease in 45%.
Interventions:
Surgical intervention comprised embolectomy in one patient (9%), bowel resection in 36% and exploratory laparotomy only in 55%.
Measures:
Hospital mortality, causes of death and long term survival were analysed.
Results:
The inhospital mortality of the 11 patients was 91% and only one female patient with arterial embolism survived after bowel resection. In the 79 patients without previous cardiac surgery the postoperative mortality of mesenteric ischemia was significantly (p<0.001) lower with 62%.
Conclusions:
Following cardiac surgery mesenteric infarction is a rare complication with an incidence of 0.06% and the chance of survival is minimal. Whenever acute abdominal disease occurs after cardiac surgery, the differential diagnosis should include mesenteric ischemia. Only an immediate surgical intervention with revascularisation and/or removal of gangrenous bowel segments may eventually improve the patient's prognosis.