Acute mesenteric embolism: An appeal for a pro-active diagnostic approach

Acute mesenteric ischaemia can be caused by arterial embolism. The initial aspecific symptoms mostly lead to late recognition of acute mesenteric ischaemia which leads to intestinal infarction. Intestinal infarction with signs of peritonitis has a very high mortality. Since 1982, a pro-active approach is followed in our department. After thorough exclusion of other causes, patients with serious acute abdominal complaints undergo an emergency angiography and/or emergency laparotomy. After confirmation of the diagnosis, primary vascular reconstructive surgery is performed if possible. We have treated eight patients with acute mesenteric embolism according to this policy. Per- and post-operatively, three patients died of extensive intestinal infarction. The five surviving patients were on a normal diet and had normal bowel functions at the time of discharge from the hospital. This limited experience shows that a pro-active approach in patients with acute mesenteric embolism can result in survival and preservation of a normally functioning alimentary tract.