Diagnosis and treatment of nonocclusive mesenteric ischemia after open heart surgery.
BACKGROUND
Acute nonocclusive mesenteric ischemia (NOMI) is a rare but often fatal event after cardiac surgery.


METHODS
Twenty patients with ongoing ileus after cardiac surgery despite maximal laxative treatment underwent selective mesenteric angiography. In cases of pathological radiographic findings, papaverine was continuously administered via an intraarterial perfusion catheter.


RESULTS
Severe NOMI was confirmed in seven patients (mean lactate: 6.9 +/- 8.3 mg/dL), mild to moderate findings in another seven (mean lactate: 1.4 +/- 1.1 mg/dL). One patient had thromboembolic occlusion of the superior mesenteric artery; five patients demonstrated normal imaging findings. In nine of fourteen patients (64%) treated with papaverine, symptoms improved within hours (defecation occurred after 4-29 hours, mean 13 +/- 8.1 hours). No side effects or complications occurred in connection with the papaverine treatment. The clinical condition of five patients deteriorated. Four patients underwent laparotomy with creation of an ileostomy or colostomy, two of whom presented with severe intestinal ischemia and later died. One patient died prior to laparotomy.


CONCLUSIONS
Selective mesenteric angiography with continuous papaverine administration is a simple, fast, and effective diagnostic and therapeutic tool to reduce the need for laparotomy for symptoms of ileus after open-heart surgery.
Klotz
S
S
Department of Cardiothoracic Surgery, University Hospital of Münster, Germany.
Vestring
T
T
Rötker
J
J
Schmidt
C
C
Scheld
H H
HH
Schmid
C
C
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging*; D010208:Papaverine / Q000008:administration & dosage*; D011859:Radiography; D012720:Severity of Illness Index; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D010208:Papaverine