Abstracts
1999 Digestive Disease Week

# 2177 ANGIOGRAPHIC AND SURGICAL APPROACH TO ACUTE MESENTERIC ISCHEMIA. A PROSPECTIVE STUDY
Juan Mier, P Sanchez, R Blanco, J Rodriguez, V Martinez, Hosp de Especialidades Ctr Medlo Nacional, Siglo XXI, Mexico City Mexico

Background: Acute Mesenteric Ischemia (AMI) is an abdominal emergency that results in a 60 to 100% mortality. Current mortality at our hospital between 1987 to 1993 was 56% and short bowel syndrome (SBS) 23% with a further mortality of 50%. Objective: To diminish reperfusion injury, mortality and SBS rates with the use of vasodilators through superior mesenteric artery (SMA). Methods: A prospective randomized trial from November 1994 to November 1997. Patients with suspected AMI were included. Three stages were considered for this approach: stage I: resuscitation and monitoring; stage II: diagnosis and therapy through mesenteric angiography, using nimodipine or nitroglycerine; stage III: exploratory celiotomy if required. Vasodilators were used in randomized form. Control group were 48 patients of our historical series. Fisher's exact text and chi-square were performed where appropriate for statistical analysis. Statistical significance was set a probability of p= <0.05. Results: Twenty-seven patients were initially studied with AMI. Abdominal pain and hemodynamic disturbances were common clinical features seen at stage I. After Stage II., 24 patients had this vascular problem. Angiographic findings were non-occlusive acute mesenteric ischemia (NOMI), 15 patients; SMA embolism in 4 patients; mesenteric venous thrombosis, 3 patients and SMA thrombosis in 2 patients. Eleven patients underwent intraarterial nitroglycerin and 13 nimodipine. After the procedure 6 patients with NOMI subside and precluded surgery. Eighteen patients required surgical exploration with intraoperative fluorescein to identify intestinal viability allowing appropriate resection of the infarcted or non-viable bowel. Average length of bowel resection was 38 cm. Overall mortality was 25%; AMI-related mortality was 20% (p-0.009). There was not SBS (p= 0.01). Conclusions: with the use of nimodipine or nitroglycerin we could diminish our mortality rate under 50% and SBS. In cases of NOMI surgical exploration was avoided with this protocol in 25% of these patients.

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