Indikation und Ergebnisse der second-look-Operation beim akuten Mesenterialgefäßverschluß

Denecke, H. J.; Stiegler, H.

doi:10.1007/978-3-642-48163-5_60

Cited by 8 publications

(3 citation statements)

References 4 publications

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“…Der Anteil der Patienten, bei denen eine Zweitoperation durchgeführt wird, liegt bei knapp über 40%, wobei in 42% positive Befunde nachzuweisen sind[20]. Eine SecondLookOperation ist aber auch dann indiziert, wenn im postoperati ven Verlauf der klinische Befund oder die metabolischen Parameter für eine persis tierende oder progrediente Darmischä mie sprechen[10].Die Ergebnisse des operativen Eingriffs und die Letalitätsrate der Erkrankung hängen letzen Endes von vielen Faktoren ab. Ob die Länge des resezierten Darm abschnittes mit der Prognose der Patien ten korreliert, wird kontrovers diskutiert.…”

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Akute mesenteriale Ischämie

Ritz

Buhr

2011

Chirurg

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Acute mesenteric ischemia (AMI) is a rare cause of acute abdomen. Coupled with a high patient age, non-specific clinical symptoms and a significant co-morbidity the disease is still associated with a significant mortality of 60-85%. With a combination of preexisting cardiac arrhythmia and sudden abdominal pain AMI should always first be ruled out. Contrast-enhanced computed tomography (CT) scanning has replaced angiography as the first diagnostic step, largely because both intravascular and intra-abdominal pathologies can be diagnosed. In the case of an acute abdomen or lack of immediate access to diagnostic tools, rapid surgical exploration should be preferred. Surgical therapy includes embolectomy and resection of ischemic bowel segments. There should be a wide indication for second-look surgery. The most important prognostic factor and the only factor that can be influenced by the surgeon is the time interval between onset of symptoms and surgery. Therefore angiography or laparotomy should be performed as early as possible in cases of suspected AMI.

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Akute mesenteriale Ischämie

Ritz

Buhr

2011

Chirurg

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“…Abhängig vom intraoperativen Befund kann bei allen Formen der akuten mesenterialen Ischämie die Indikation zu einer "Second-Look"-Operation oder alternativ zur "Second-Look"-Laparoskopie [12,15,29,39,42] …”

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Die akute mesenteriale Ischämie – häufig übersehen und häufig letal

Lock¹

2002

Med Klin

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“…Einige Autoren halten diesen Parameter ffir wenig hilfreich und verlassen sich eher auf die charakteristischen Merkmale bestehender Risikofaktoren dieser Patientengruppe [4,7,22]. Andere Autoren werten eine LaktaterNShung als wichtigen Parameter der Diagnostik in der prfioperativen Abkl~irung und ziehen diesen Wert auch im postoperativen Verlauf nach intraabdominallen Geffigrekonstruktionen zur Indikationsstetlung einer (Second-look-)Operation heran [1,16].…”

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Das Verhalten des Laktatspiegels bei Okklusion und Reperfusion der A. mesenterica superior

Jonas

Schwarz

Alebrahim-Dehkordy

1996

Langenbecks Arch Chir

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The value of lactate in the early clinical diagnosis of acute mesenteric arterial occlusion was evaluated in an animal model. The superior mesenteric artery of pigs (8-9 weeks old, 20-23 kg) was clamped for 1 h (group 2, n = 9) and 3 h (group 3, n = 6). Reperfusion was recorded for 2 h. Follow-up measurements were done in six animals (group 1). The systolic blood pressure was elevated significantly to about 18-40 mmHg in the initial phase of ischemia (P = 0.02). The intramucosal pHi measured tonometrically was decreased to below a value of 7.08 (P = 0.03), and the flow of superior mesenteric vein was reduced by about 90% ( P = 0.03) in groups 2 and 3. Within 30 min the lactate increased to about 2.05-3.8 mmol/l in the central venous blood sample and 2.8-4.8 mmol/l in the portal vein blood sample in 30 min. After 3 h of ischemia (group 3) the elevated lactate level returned to normal without any significant difference. In the reperfusion period (group 2) the systolic blood pressure stabilized at a depressed level (63-73 mmHg, P = 0.0054), and the flow of the superior mesenteric vein showed a reduction of 41% (P = 0.03). Intramucosal pHi and lactate values returned nearly completely to normal within 2 h. Reperfusion after 3 h of ischemia (group 3) caused marked shock without any sign of recovery at intramucosal pH or mesenteric vein flow. The lactate values increased for above the ischemic level. In conclusion, an elevated lactate level only correlates with the initial phase of acute mesenteric arterial occlusion. A normal lactate concentration cannot exclude the diagnosis of mesenteric ischemia. Reperfusion of the ischemic intestine is characterized by circulatory shock with secondary increased lactate concentration without predictive value for adequate intestinal perfusion.

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Indikation und Ergebnisse der second-look-Operation beim akuten Mesenterialgefäßverschluß

Cited by 8 publications

References 4 publications

Akute mesenteriale Ischämie

Akute mesenteriale Ischämie

Die akute mesenteriale Ischämie – häufig übersehen und häufig letal

Das Verhalten des Laktatspiegels bei Okklusion und Reperfusion der A. mesenterica superior

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