Acute Mesenteric Ischæmia

Abstract

The experience of acute mesenteric ischæmia at St Vincent's Hospital, Melbourne, has been reviewed over 17 years. The mortality remains appallingly high. This applies particularly to those patients who had thrombosis of the superior mesenteric artery, amongst whom the mortality in this series was 97%. The mortality was slightly less in the group suffering from embolic occlusion of the superior mesenteric artery (66%), and in those suffering from thrombosis of the superior mesenteric vein (60%). A mortality of 66% was also found in patients suffering from non‐occlusive gut ischæmia. Delay in diagnosis accounted for this high mortality. Early diagnosis is all‐important, and this depends on the performance of mesenteric angiography in any patient suspected of having mesenteric ischæmia. Appropriate surgery may then be carried out in the occlusive group and supportive treatment, including intraarterial papaverine infusion, given to those with non‐occlusive ischæmia. There is a pressing need for simple non‐invasive tests to segregate those patients suffering from acute mesenteric ischæmia from those whose acute abdomen is due to some other cause.

Systematic review of survival after acute mesenteric ischaemia according to disease aetiology

“…The 45 studies35–79 included in the analysis are listed chronologically in Table 1 . Only observational studies were identified, of which one was prospective and 44 were retrospective case series, published between 1967 and 2002.…”

Acute Mesenteric Ischemia: The Challenge of Gastroenterology

“…37 Several retrospective studies have shown that prompt diagnosis improves the survival rate significantly. Another study found that the intestine was viable in over 90% of patients if the duration of symptoms was less than 12 h. 6 The plain X-ray findings suggestive of AMI include a thickened bowel wall and a "ground-glass appearance" in the abdomen. 38 However, as these findings are nonspecific and the condition is associated with a high mortality rate, plain X-ray films are considered to be useful only for excluding other possible causes of acute abdominal pain, such as a perforated peptic ulcer.…”

“…Above all, acute mesenteric ischemia (AMI) is often lethal and in-hospital mortality rates have remained high over the last 20 years, at 60%-80%. [1][2][3][4][5][6][7][8][9][10][11][12] Although AMI accounts for only about 1%-2% of gastrointestinal illnesses, 10 the incidence has been increasing considerably. 13,14 It is paradoxical that cardiovascular surgeons 15 and nephrologists 16 are more familiar with this emergency abdominal condition than gastroenterologists, but they are very likely to encounter AMI in patients undergoing major vascular surgery and those on hemodialysis.…”

Death by midgut infarction: clinical lessons from 88 post‐mortems in Auckland, New Zealand

“…It is underreported 9 and increasing in ageing societies 3,10 . This series is one of few from Australia and New Zealand and identifies several pointers to improved clinical performance 11 …”