Acute Mesenteric Ischemic Disease

Choi, Seok Ho; Min, Seung Kee; Jung, In Mok; Ha, Jongwon; Park, Jae Gahb; Kim, Jin Pok; Kim, Sang Joon

Abstract

Acute mesenteric ischemia remains to cause high mortality in spite of the marked development of diagnostic tools and surgical techniques in the area of vascular surgery. The reason why the disease has a high mortality is mainly the delayed diagnosis. If diagnosis and treatment are established early enough to prevent irreversible change of bowel, the prognosis might be favorable. Twenty patients with a disease of acute mesenteric ischemia who received surgical or interventional treatment were studied by retrospective manner. There were 12 men and 8 women. The mean age was 57.3 years (22~81 years). Underlying cardiovascular disease including valvular lesion and arrhythmia was the most commonly associated disease. The etiologies of ischemia were embolism of superior mesenteric artery in 9 cases, thrombosis of superior mesenteric artery in 1, thrombosis of superior mesenteric vein in 5, one non-occlusive (vasoconstrictive) mesenteric ischemia and unknown in 4 cases. Two patients received radiological interventional treatment with urokinase and papaverine respectively. Eighteen patients were undergone surgical treatment including revascularization and bowel resection. Second-look procedures for bowel resection were performed in 4 cases. Complications occured in 10 cases, wound infection in 5, sepsis in 3, short bowel syndrome in 2 and anastomotic site leakage in 2. Early postoperative mortality occured in 3 cases and late mortality in 2. The cornerstone in the management of the disease is early diagnosis and prompt interventional (radiologic or surgical) treatments before irreversible change was established. Therefore, with a high index of suspicion, early and aggressive angiographic diagnosis and interventional procedures should be carried out.