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.
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.
Authors: G Luckner; S Jochberger; V D Mayr; H Knotzer; W Pajk; V Wenzel; B Friesenecker; I Lorenz; M W Dünser Journal: Anaesthesist Date: 2006-03 Impact factor: 1.041