Diagnosis, Therapeutic Strategy and Prognosis of Acute Mesenteric Vascular Occlusion: Results of a Consecutive Series

Abstract

In a consecutive series on the patient material of the Johannes Gutenberg University, Mainz, the value of the preoperative diagnosis as well as the prognostically relevant factors in the case of acute mesenteric vascular occlusion (AMVO) were investigated. From September 1, 1985, until April 1, 1990, 50 patients (24 men, 26 women), with an average age of 67.2 years, were treated for AMVO. Twenty-eight patients died postoperatively. A leukocytosis of approximately 21,000 /nl was discovered in all patients. With the exception of 5 cases (90%) the lactate level had pathologically increased. The phosphate level in 10 of 35 patients (28.6%) also increased. None of the patients were suspected of having AMVO on the basis of abdominal X-rays. AMVO was suspected in 5 patients who underwent sonography. Angiography had a sensitivity of 73.3%. The postoperative mortality was statistically significantly dependent on the patient’s anamnesis, the etiology of the occlusion, the patient’s age, the preoperative ASA score and the length of the ischemically damaged bowel. The postoperative serum lactate level correlated closely with the patient’s outcome. 10% of the patients survived 2 years.