Infarto intestinale. La gestione dei pazienti e i nostri casi clinici


COD: 04_2010_307-310 Categorie: ,

Antonio Biondi, Alessandro Tropea, Giuliana Monaco, Nicola Musmeci, Sergio Calì, Francesco Basile

Ann. Ital. Chir., 2010; 81: 307-310

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AIM OF THE STUDY: Intestinal infarction is caused by secondary ischemic damage due to partial or complete obstruction
of blood flow usually of arterial origin. About 50% of acute mesenteric infarctions are due to superior mesenteric artery
emboli. Arterial thrombosis are most commonly caused to atherosclerosis, less commonly vasculitis, or hypercoaguable states.
Venous thrombosis represents only 5-10% of cases usually associated with an hypercoagulable state, less commonly
inflammation, portal hypertension or trauma. Non occlusive ischemia may represent up to 25% of acute mesenteric
infarction, and is most commonly associated with shock, cardiac arrhythmia or acute pulmonary edema.
MATERIAL AND METHODS: From January 2002 to March 2007, 19 patients with intestinal infarction were treated, at
the General Surgery and Oncology Department of Catania University. All patients were submitted to RX direct(RX) and
computed tomography(CT). In 94,7% of patients RX has demonstrated clear bowel gaseous distension. Preoperative arteriography
was carried out in 15,7%, whereas multislice angio-CT only in 36,8%. Second look laparotomy was executed
to evaluate the effectiveness of treatments.
RESULTS: In 2/19(10,5%) embolectomy of superior mesenteric artery were executed and in one case 30cm of ileo resection
only. In another 10,5% cases a surgical revascolarization of intestinal arteries with an anterograde by-pass technique
was carried out. A resection with anastomosis has been necessary in 78,9% but in 26% of these procedures a second
look laparotomy was necessary.
DISCUSSION: Three months survival was showed in 36,8% of patients. Completion angiography showed successful recanalization
of the superior mesenteric artery without any complication and with satisfactory distal flow. Symptoms of the
patients were alleviated.
CONCLUSION: Mesenteric ischaemia is a relatively uncommon cause of abdominal pain, but one with significant mortality.