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Acute mesenteric vascular occlusion: analysis of 39 patients
H Urayama1, H Ohtake, T Kawakami
1First Department of Surgery, Kanazawa University School of Medicine, Ishikawa, Japan.
Objective:
To study the factors that influence mortality and long term outcome of patients with acute mesenteric vascular occlusion.
Design:
Retrospective study.
Setting:
University hospital, Kanazawa, Japan.
Patients:
Thirty-nine patients treated between 1978 and 1995 for acute mesenteric vascular occlusion.
Interventions:
34 patients underwent laparotomy. Bowel was resected in 29 patients, and primary anastomosis was done in 20. The occluded vessel was revascularised in 5 patients.
Main Outcome Measures:
mortality, short bowel syndrome and long term survival.
Results:
25 patients had arterial occlusions, and 8 venous. In the remaining 6, the occluded vessel was not identified. 11 Patients developed renal failure, 11 respiratory failure, and 10 disseminated intravascular coagulation (DIC). Twelve patients died within 30 days. The factors associated with early death were acidosis and high serum amylase activity. 9 Patients developed the short bowel syndrome. Survival was 49% at 1 year, and 34% at 5 years.
Conclusion:
Mortality was higher in patients with advanced peritonitis. Mesenteric revascularisation should be attempted to avoid the short bowel syndrome.