Abstracts
1999 Digestive Disease Week

# 2176 MESENTERIC INFARCTION IS A HOSPITAL ACQUIRED CONDITION
Jeffrey S Bender, Tamara S Newman, Melissa A Smith-Meek, Thomas H Magnuson, Johns Hopkins Bayview Med Ctr, Baltimore, MD

Introduction: Mortality from mesenteric infarction remains high. It has been our impression that at our institution many patients develop infarction as a complication after admission. We performed a study to see whether this was justified. Methods: A retrospective review of all patients diagnosed with mesenteric infarction at one hospital from January 1, 1990 to December 31, 1997 was performed. Charts were reviewed for admission diagnosis, demographic data, overall outcome and length of stay (LOS). Particular attention was paid to those that developed mesenteric infarction following admission for an unrelated cause. Results: A total of 133 patients were identified. Exclusion of those who presented in extremis in which only comfort measures were provided (n=23) and of those with small bowel obstruction as the underlying etiology (n=22) left 88 patients for further analysis. Thirty-four of these patients (38.6%) developed mesenteric infarction following admission for an unrelated cause. These 34 patients were further divided into two groups. At the time of diagnosis, group I patients (n=15) were on the medical service and group II patients were on the surgical service (n=19). All patients hospitalized three days or less prior to diagnosis developed infarction following a vascular surgery procedure. Conclusions: Thirty-nine percent of potentially salvageable patients with mesenteric infarction develop this condition following admission for an unrelated cause. The diagnosis is accompanied by a high mortality and a prolonged length of stay for survivors. As the overwhelming number are already in an intensive care unit from their admitting problems, it seems likely that mesenteric infarction is another manifestation of the multi-system organ failure syndrome. The development of unexplained acidosis or sepsis in an already critically ill patient should prompt a search for a correctable cause of mesenteric ischemia.

	Group I (n=15)	Group II (n=19)	p
Mean age (years)	62.3±4.5	64.7±3.2	n.s.
ICU prior to diagnosis	14	19	n.s.
LOS prior to diagnosis (days)	14.9±6.1	7.1±1.9	<0.03
LOS after diagnosis (days)	36.1±10.1	26.5±7.8	n.s.
Mortality	5 (33%)	6 (32%)	n.s.

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