Gut ischaemia following cardiac surgery
- Resource Type
- Authors
- C. Ratnatunga; C.T. Lewis; R. Pillai; S. Hasan
- Source
- Interactive cardiovascular and thoracic surgery. 3(3)
- Subject
- Pulmonary and Respiratory Medicine
medicine.medical_specialty
business.industry
medicine.medical_treatment
Ischemia
Infarction
medicine.disease
Non occlusive mesenteric ischemia
Cardiac surgery
Surgery
Mesenteric ischaemia
Cecum
medicine.anatomical_structure
Laparotomy
Terminal ileum
Medicine
cardiovascular diseases
Cardiology and Cardiovascular Medicine
business
- Language
- ISSN
- 1569-9285
Gut ischaemia following cardiac surgery carries a high mortality and is usually due to non-occlusive mesenteric ischaemia. We reviewed 4464 patients undergoing cardiac surgery over a 5-year period. Sixteen of them developed gut ischaemia post-operatively, 13 of whom were discovered at laparotomies while the remaining 3 were post-mortem diagnoses. Eleven patients were found to have extensive ischaemia and all 11 died irrespective of the treatment and the delay in diagnosis. In five patients ischaemia was localized, involving the caecum in three and terminal ileum in two. They all underwent local resections and survived. The differences in the groups were analysed and the average time between onset of symptoms and laparotomies was longer in the localized ischaemia group compared to the extensive ischaemia group. Our experience illustrates the continuing difficulty in diagnosis of mesenteric ischaemia before gut infarction has occurred. We conclude that different pathologies might be involved in post-cardiac surgery gut ischaemia and although early diagnosis and treatment is considered to be crucial, early laparotomies do not necessarily equate to survival in cases of extensive ischaemia. There is a need to evaluate aggressive strategies for early diagnosis if prognosis is to be improved in these cases.