The intestinal infarct. Personal casistics and management of the patients

Abstract

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.