[Acute mesenteric vascular occlusion].
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This report concerns 70 cases of occlusion of the mesenteric vessels, 32 arterial and 38 venous. Clinical symptoms and possibilities of therapy are discussed. Operative therapy was carried out in only 19 patients, 5 of whom survived. The time between the first symptoms and the operation essentially influences the prognosis. Postoperative anti-coagulation seems to be significant. The value of a 'second-look' operation is dubious.
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High mortality rates associated with mesenteric occlusion are a tremendous challenge. We reviewed 32 patients admitted to Beckley Appalachian Regional Hospital during the years 1965 to 1974. The majority of the patients were men. There was quite a variation in the symptoms and physical signs, with heart disease commonly associated with mesenteric occlusion. Massive gangrene involving the small and large bowels had the worst prognosis. Thrombectomy and anticoagulation did not prove beneficial in our series. Patients who survived massive resection are having intermittent diarrhea, responsive to medical treatment. The mortality rate in this series of 32 patients was 81.3 percent. It is hoped that with increased use of mesenteric angiography, early diagnosis, and prompt management the mortality rate can be brought down to acceptable levels.
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Long-standing complete obstruction of the superior mesenteric artery and vein and recurrent gastrointestinal bleeding from varices within the bowel were encountered in a child as a complication of midgut malrotation and volvulus. This condition is unusual, but should be considered in cases of gastrointestinal bleeding, or when small bowel biopsy is contemplated for the evaluation of diarrhea or malabsorption in cases of malrotation.