Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1975 Oct;182(4):430–438. doi: 10.1097/00000658-197510000-00008

Revascularization in treatment of mesenteric infarction.

J J Bergan, R H Dean, J Conn Jr, J S Yao
PMCID: PMC1344005  PMID: 1180581

Abstract

This study compares results of primary revascularization with primary intestinal resection in treatment of acute mesenteric artery occlusion in 48 surgical patients. All cases were verified by surgical exploration, angiography or autopsy. Fifteen occlusions were caused by mesenteric thrombosis and 33 by superior mesenteric artery embolization. Primary revascularization was done in 6 of 15 patients with arteriosclerotic mesenteric thrombosis. Total bowel salvage was achieved in 4 patients but no patient with mesenteric thrombosis treated by any method survived long term. Primary embolectomy was done in 11 patients with superior mesenteric artery embolization. Ttoal bowel salvage was achieved in 8 patients. Three of 11 patients died. Primary exploration and/or resection was done in 11 patients; 9 died. All 11 umoperated patients died. A continuation of attempts at mesenteric revascularization is advocated.

Full text

PDF
430

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aho A. J., Arstila A. U., Ahonen J., Inberg M. V., Scheinin T. M. Ultrastructural alterations in ischaemic lesion of small intestinal mucosa in experimental superior mesenteric artery occlusion. Effect of oxygen breathing. Scand J Gastroenterol. 1973;8(5):439–447. [PubMed] [Google Scholar]
  2. BERGAN J. J., COPASS M. K., 2nd, HOEHN J. G. SYSTEMIC HYPERKALEMIA AFTER SUCCESSFUL MESENTERIC EMBOLECTOMY. Am J Surg. 1965 Jun;109:805–806. doi: 10.1016/s0002-9610(65)80056-3. [DOI] [PubMed] [Google Scholar]
  3. BERGAN J. J., GILLILAND V., TROOP C., ANDERSON M. C. HYPERKALEMIA FOLLOWING INTESTINAL REVASCULARIZATION. JAMA. 1964 Jan 4;187:17–19. doi: 10.1001/jama.1964.03060140023005. [DOI] [PubMed] [Google Scholar]
  4. BERGAN J. J., HOEHN J. G. SUPERIOR MESENTERIC ARTERY EMBOLECTOMY. JAMA. 1964 Jun 8;188:935–936. doi: 10.1001/jama.1964.03060360095023. [DOI] [PubMed] [Google Scholar]
  5. BRITTAIN R. S., EARLEY T. K. EMERGENCY THROMBO-ENDARTERECTOMY OF THE SUPERIOR MESENTERIC ARTERY: REPORT OF FOUR CASES. Ann Surg. 1963 Jul;158:138–143. doi: 10.1097/00000658-196307000-00026. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Beal J. M. Mesenteric embolus. Case report. IMJ Ill Med J. 1972 Aug;142(2):121–123. [PubMed] [Google Scholar]
  7. Bergan J. J., Dry L., Conn J., Jr, Trippel O. H. Intestinal ischemic syndromes. Ann Surg. 1969 Jan;169(1):120–126. doi: 10.1097/00000658-196901000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Bergan J. J., Dry L., Conn J., Jr, Trippel O. H. Intestinal ischemic syndromes. Proc Inst Med Chic. 1968 May;27(3):59–59. [PubMed] [Google Scholar]
  9. Bergan J. J., Haid S. P., Conn J., Jr Systemic effects of intestinal revascularization. Am J Surg. 1969 Feb;117(2):235–241. doi: 10.1016/0002-9610(69)90309-2. [DOI] [PubMed] [Google Scholar]
  10. Bergan J. J. Possibilities in prevention of intestinal and somatic death. Am J Dig Dis. 1967 Aug;12(8):850–852. doi: 10.1007/BF02236252. [DOI] [PubMed] [Google Scholar]
  11. Bergan J. J. Recognition and treatment of intestinal ischemia. Surg Clin North Am. 1967 Feb;47(1):109–126. doi: 10.1016/s0039-6109(16)38137-3. [DOI] [PubMed] [Google Scholar]
  12. Bergan J. J. Recognition and treatment of superior mesenteric artery embolization. Geriatrics. 1969 Feb;24(2):118–125. [PubMed] [Google Scholar]
  13. Bounous G., McArdle A. H. Release of intestinal enzymes in acute mesenteric ischemia. J Surg Res. 1969 Jun;9(6):339–346. doi: 10.1016/0022-4804(69)90078-x. [DOI] [PubMed] [Google Scholar]
  14. Brown R. A., Chiu C. J., Scott H. J., Gurd F. N. Ultrastructural changes in the canine ileal mucosal cell after mesenteric arterial occlusion. Arch Surg. 1970 Aug;101(2):290–297. doi: 10.1001/archsurg.1970.01340260194029. [DOI] [PubMed] [Google Scholar]
  15. Chiu C. J., Scott H. J., Gurd F. N. Circulatory collapse following the restoration of blood flow to the occluded superior mesenteric artery. Surg Forum. 1970;21:47–49. [PubMed] [Google Scholar]
  16. DUMONT A. E., TICE D. A., MULHOLLAND J. H. Arteriosclerotic occlusion of the superior mesenteric artery: observations concerning surgical treatment. Ann Surg. 1961 Nov;154:833–838. doi: 10.1097/00000658-196111000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Elliot J. W. II. The Operative Relief of Gangrene of Intestine Due to Occlusion of the Mesenteric Vessels. Ann Surg. 1895 Jan;21(1):9–23. doi: 10.1097/00000658-189521060-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Glenn T. M., Lefer A. M. Role of lysosomes in the pathogenesis of splanchnic ischemia shock in cats. Circ Res. 1970 Nov;27(5):783–797. doi: 10.1161/01.res.27.5.783. [DOI] [PubMed] [Google Scholar]
  19. Gusberg R., Gump F. E. Combined surgical and nutritional management of patients with acute mesenteric vascular occlusion. Ann Surg. 1974 Mar;179(3):358–361. doi: 10.1097/00000658-197403000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. JENSON C. B., SMITH G. A. A clinical study of 51 cases of mesenteric infarction. Surgery. 1956 Nov;40(5):930–937. [PubMed] [Google Scholar]
  21. KLASS A. A. Acute mesenteric arterial occlusion: restoration of blood flow by embolectomy. J Int Coll Surg. 1953 Dec;20(6):687–694. [PubMed] [Google Scholar]
  22. KLASS A. A. Embolectomy in acute mesenteric occlusion. Ann Surg. 1951 Nov;134(5):913–917. doi: 10.1097/00000658-195111000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. KOBOLD E. E., THAL A. P. QUANTITATION AND IDENTIFICATION OF VASOACTIVE SUBSTANCES LIBERATED DURING VARIOUS TYPES OF EXPERIMENTAL AND CLINICAL INTESTINAL ISCHEMIA. Surg Gynecol Obstet. 1963 Sep;117:315–322. [PubMed] [Google Scholar]
  24. LILLEHEI R. C., LONGERBEAM J. K., BLOCH J. H., MANAX W. G. THE NATURE OF IRREVERSIBLE SHOCK: EXPERIMENTAL AND CLINICAL OBSERVATIONS. Ann Surg. 1964 Oct;160:682–710. doi: 10.1097/00000658-196410000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lefer A. M. Role of a myocardial depressant factor in the pathogenesis of circulatory shock. Fed Proc. 1970 Nov-Dec;29(6):1836–1847. [PubMed] [Google Scholar]
  26. Liavåg I. Acute mesenteric vascular insufficiency. A five-year material, including a case of successful superior mesenteric artery embolectomy. Acta Chir Scand. 1967;133(8):631–639. [PubMed] [Google Scholar]
  27. MARSTON A. CAUSES OF DEATH IN MESENTERIC ARTERIAL OCCLUSION. I. LOCAL AND GENERAL EFFECTS OF DEVASCULARIZATION OF THE BOWEL. Ann Surg. 1963 Dec;158:952–959. doi: 10.1097/00000658-196312000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. MARSTON A. CAUSES OF DEATH IN MESENTERIC ARTERIAL OCCLUSION. II. OBSERVATIONS ON REVASCULARIZATION OF THE ISCHEMIC BOWEL. Ann Surg. 1963 Dec;158:960–970. doi: 10.1097/00000658-196312000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. MAVOR G. E., LYALL A. D., CHRYSTAL K. M., TSAPOGAS M. Mesenteric infarction as a vascular emergency. The clinical problems. Br J Surg. 1962 Sep;50:219–225. doi: 10.1002/bjs.18005022020. [DOI] [PubMed] [Google Scholar]
  30. MIKKELSEN W. P. Intestinal angina: its surgical significance. Am J Surg. 1957 Aug;94(2):262-7; discussion, 267-9. doi: 10.1016/0002-9610(57)90654-2. [DOI] [PubMed] [Google Scholar]
  31. MIKKELSEN W. P., ZARO J. A., Jr Intestinal angina; report of a case with preoperative diagnosis and surgical relief. N Engl J Med. 1959 Apr 30;260(18):912–914. doi: 10.1056/NEJM195904302601804. [DOI] [PubMed] [Google Scholar]
  32. MILLIKEN J., NAHOR A., FINE J. A STUDY OF THE FACTORS INVOLVED IN THE DEVELOPMENT OF PERIPHERAL VASCULAR COLLAPSE FOLLOWING RELEASE OF THE OCCLUDED SUPERIOR MESENTERIC ARTERY. Br J Surg. 1965 Sep;52:699–704. doi: 10.1002/bjs.1800520917. [DOI] [PubMed] [Google Scholar]
  33. Marston A. Mesenteric arterial disease: the present position. Gut. 1967 Jun;8(3):203–205. doi: 10.1136/gut.8.3.203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Mathews J. E., White R. R. Primary mesenteric venous occlusive disease. Am J Surg. 1971 Nov;122(5):579–583. doi: 10.1016/0002-9610(71)90282-0. [DOI] [PubMed] [Google Scholar]
  35. Ottinger L. W., Austen W. G. A study of 136 patients with mesenteric infarction. Surg Gynecol Obstet. 1967 Feb;124(2):251–261. [PubMed] [Google Scholar]
  36. Pierce G. E., Brockenbrough E. C. The spectrum of mesenteric infarction. Am J Surg. 1970 Mar;119(3):233–239. doi: 10.1016/0002-9610(70)90042-5. [DOI] [PubMed] [Google Scholar]
  37. SELKURT E. E., SCIBETTA M. P., CULL T. E. Hemodynamics of intestinal circulation. Circ Res. 1958 Jan;6(1):92–99. doi: 10.1161/01.res.6.1.92. [DOI] [PubMed] [Google Scholar]
  38. SHAW R. S., RUTLEDGE R. H. Superior-mesenteric-artery embolectomy in the treatment of massive mesenteric infarction. N Engl J Med. 1957 Sep 26;257(13):595–598. doi: 10.1056/NEJM195709262571303. [DOI] [PubMed] [Google Scholar]
  39. STEWART G. D., SWEETMAN W. R., WESTPHAL K., WISE R. A. Superior mesenteric artery embolectomy. Ann Surg. 1960 Feb;151:274–278. doi: 10.1097/00000658-196002000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. SWANK R. L., HISSEN W., BERGENTZ S. E. 5-HYDROXYTRYPTAMINE AND AGGREGATION OF BLOOD ELEMENTS AFTER TRAUMA. Surg Gynecol Obstet. 1964 Oct;119:779–784. [PubMed] [Google Scholar]
  41. SWANK R. L., HISSEN W., FELLMAN J. H. 5-HYDROXYTRYPTAMINE (SEROTONIN) IN ACUTE HYPOTENSIVE SHOCK. Am J Physiol. 1964 Jul;207:215–222. doi: 10.1152/ajplegacy.1964.207.1.215. [DOI] [PubMed] [Google Scholar]
  42. Slater H., Elliott D. W. Primary mesenteric infarction. Am J Surg. 1972 Mar;123(3):309–311. doi: 10.1016/0002-9610(72)90291-7. [DOI] [PubMed] [Google Scholar]
  43. Swan K. G., Jacobson E. D. Hemodynamics of endotoxin shock in the conscious animal. Surg Gynecol Obstet. 1967 Nov;125(5):1041–1046. [PubMed] [Google Scholar]
  44. Trinkle J. K., Rush B. F., Fuller M. A., Bryant L. R., Rams J. The operative management of idiopathic mesenteric venous thrombosis with intestinal infarction. Am Surg. 1969 May;35(5):338–341. [PubMed] [Google Scholar]
  45. Williams L. F., Jr, Goldberg A. H., Polansky B. J., Byrne J. J. Myocardial effects of intestinal ischemia. J Surg Res. 1969 May;9(5):319–323. doi: 10.1016/0022-4804(69)90073-0. [DOI] [PubMed] [Google Scholar]
  46. ZIMBERG Y. H. Mesenteric arterial occlusion. Va Med Mon (1918) 1963 Jul;90:318–325. [PubMed] [Google Scholar]
  47. ZUIDEMA G. D., REED D., TURCOTTE J. G., FRY W. J. SUPERIOR MESENTERIC ARTERY EMBOLECTOMY. Ann Surg. 1964 Apr;159:548–553. doi: 10.1097/00000658-196404000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Zschenker H. Uber die Behandlung eines Mesenterialveneverschlusses durch Thrombektomie, ausgedehnte Dünndarmresektion und nachfolgende Streptasebehandlung. Chirurg. 1971 Jul;42(7):332–333. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES