Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 21, 2008; 14(35): 5361-5370
Published online Sep 21, 2008. doi: 10.3748/wjg.14.5361
Acute mesenteric ischemia after cardio-pulmonary bypass surgery
Bassam Abboud, Ronald Daher, Joe Boujaoude
Bassam Abboud, Ronald Daher, Department of General Surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 16-6830, Lebanon
Joe Boujaoude, Department of Gastroenterology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 16-6830, Lebanon
Author contributions: Abboud B designed research; Daher R, Abboud B and Boujaoude J performed research, Daher R and Abboud B wrote the paper.
Correspondence to: Bassam Abboud, MD, Department of General Surgery, Hotel Dieu de France Hospital, Alfred Naccache Street, Beirut 16-6830, Lebanon. dbabboud@yahoo.fr
Telephone: +961-1-615300 Fax: +961-1-615295
Received: May 28, 2008
Revised: July 14, 2008
Accepted: July 21, 2008
Published online: September 21, 2008

Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, is the only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

Keywords: Acute mesenteric ischemia, Non-occlusive, Cardio-pulmonary bypass, Laparotomy, Prognosis, Mortality