[Non-occlusive mesenteric infarction following cardiovascular surgery].
In the majority of patients with intestinal infarction, it is generally agreed that the occlusion of mesenteric arteries or vein is the primary etiologic factor; however, some showed no evidence of thrombosis, embolization or vasculitis as the causative factor. In many patients, this particular type of infarction is the terminal event of the episode. From October 1977 to December 1986, 24 patients with mesenteric infarction were investigated following cardiovascular surgery in our institute. Among them, 15 were diagnosed with organic vascular occlusion; however, the other 9 showed no evidence of thromboembolism or any other organic vascular occlusive lesion of mesenteric vessels and were diagnosed as non-occlusive mesenteric infarctions. All of these patients were in severe cardiac failure (LOS) postoperatively. There was no typical symptom, although abdominal fullness and diarrhea were the major and consistent findings. In blood chemical analysis, the enzymatic levels such as serum GOT, LDH and CPK were significantly elevated and discrepancy between serum GOT and serum GPT was observed. In this clinical situation, it was difficult to establish a correct diagnosis mainly because of the few signs and symptoms present relating to the mesenteric infarction. On the other hand, when the correct diagnosis was made, these patients were too critically ill to be treated conservatively. The outcome of these patients was grave and all of them died which showed 100% of mortality rate. The conservative management did not produce favorable progress, which accelerated LOS and prevented patients from recovering from cardiac failure. The aggressive surgical approach to this particular type of acute mesenteric ischemia might have offered an improved prognosis from these catastrophic events.
Kawaguchi
O
O
Department of Cardiovascular Surgery, National Cardiovascular Center Hospital, Osaka, Japan.
Kumon
K
K
Hirata
T
T
Tanaka
K
K
Kitou
Y
Y
Nakajima
N
N
Fujita
T
T
D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000150:complications; D002318:Cardiovascular Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007238:Infarction / Q000209:etiology*; D008297:Male; D008638:Mesenteric Arteries; D008642:Mesenteric Veins; D008875:Middle Aged; D011183:Postoperative Complications