[Acute mesenteric ischemia].
Acute mesenteric ischemia is a life-threatening vascular emergency. A retrospective analysis of our patients was performed to describe the development of the various procedures of diagnostic assessment and treatment between 1970 and 1996, to show the influence on survival and to define recent standards.


METHODS
Between 1970 and 1996, 145 patients, 75 male and 70 female, suffering from acute mesenteric ischemia, have been treated at the Department of Surgery-University Hospital Vienna.


RESULTS
In most cases AMI was caused by arterial embolism (64.1%, n = 93) followed by arterial thrombosis (27.6%, n= 40). Venous thrombosis (3.5%, n = 5) and non-occlusive AMI (4.8%, n = 7) were rare events. Serum lactate level has been determined routinely in all patients having been admitted with acute abdomen since 1984 and turned out to be positive in 81.2% (mean value 9.81 (3.21-22.3) mmol/l). Abdominal x-ray gave only in some individual cases special hints to the advanced intestinal gangrene. Abdominal sonography led to the correct diagnostic assessment in 52 patients (= 35.8%). Angiography was in 92% conclusive for the diagnosis. Abdominal CT led to establish the correct diagnosis in > 80%. Our series with revascularisation (thrombectomy/embolectomy or bypass) has resulted in 73.8% patient survival with intestine having been maintained in the most favourable cases.


CONCLUSIONS
Early diagnostic assessment and treatment are decisive for survival. Abdominal-CT, angiography and serum-lactate constitute quick and reliable means to provide diagnosis and to judge the stage of AMI in addition to meticulous examination of patients' history, symptoms and physical conditions.
Czerny
M
M
Klinische Abteilung für Gefässchirurgie, Universität Wien.
Trubel
W
W
Claeys
L
L
Scheuba
C
C
Huk
I
I
Prager
M
M
Polterauer
P
P
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004617:Embolism / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D004630:Emergencies; D005260:Female; D006801:Humans; D007422:Intestines / Q000098:blood supply; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008642:Mesenteric Veins / Q000601:surgery; D008643:Mesentery / Q000098:blood supply*; D008875:Middle Aged; D011237:Predictive Value of Tests; D015996:Survival Rate; D013927:Thrombosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D019344:Lactic Acid