Skip to main content


Log in

Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript



Acute intestinal ischemia (AII) is an uncommon surgical emergency that has been increasing in incidence and remains a highly lethal condition with a difficult diagnosis. We undertook this study to evaluate our experience in treating this condition with a view to expand the cumulative information in the literature.

Materials and methods

Between January 2000 and December 2006, 60 patients with AII caused by thrombotic vascular event underwent surgery at our surgical center. The patients’ medical records including data covering demographic features, comorbid medical conditions, medical risk factors, clinical symptoms, history and physical examination findings, and biochemical and radiologic examinations were reviewed. Operative records, the American Society of Anesthesiology physical status classification (ASA-PS), postoperative complications, duration of hospital stay, and final outcome were also considered.


Of the 60 patients with primary thrombotic vascular event, 20 patients had embolism and 19 patients arterial thrombosis. In 21 patients, mesenteric venous thrombosis was the etiology of AII. The median age was 73 years (range, 43–96). Higher ASA classification, age >70 years, late presentation, and high serum lactate levels were predictors of adverse outcome. The overall death rate was 60% (36/60), which was within the range of that observed in the published series.


AII remains a highly lethal condition. Mortality rates remain as high as they did decades ago due in part to advanced presentation and advanced age with multiple associated conditions and risk factors, all of which are independent predictors of adverse outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Stoney RJ, Cunningham CG (1993) Acute mesenteric ischemia. Surgery 114:489–490

    PubMed  CAS  Google Scholar 

  2. Brandt LJ, Boley SJ (2000) AGA technical review on intestinal ischemia. Gastroenterology 118:954–968

    Article  PubMed  CAS  Google Scholar 

  3. Martinez JP, Hogan GJ (2004) Mesenteric ischemia. Emerg Med Clin North Am 22:909–928

    Article  PubMed  Google Scholar 

  4. Sachs SM, Morton JH, Schwartz SI (1982) Acute mesenteric ischemia. Surgery 92:646–653

    PubMed  CAS  Google Scholar 

  5. Klempnauer J, Grothues F, Bektas H, Pichlmayr R (1997) Long-term results after surgery for acute mesenteric ischemia. Surgery 121:239–243

    Article  PubMed  CAS  Google Scholar 

  6. Falkensammer J, Oldenburg WA (2006) Surgical and medical management of mesenteric ischemia. Curr Treatm Opt Cardiovasc Med 8:137–143

    Article  Google Scholar 

  7. Ottinger LW (1978) The surgical management of acute occlusion of the superior mesenteric artery. Ann Surg 188:721–731

    Article  PubMed  CAS  Google Scholar 

  8. Safioleas MC, Moulakakis KG, Papavassiliou VG, Kontzoglou K, Kostakis A (2006) Acute mesenteric ischemia, a highly lethal disease with a devastating outcome. Vasa 35:106–111

    Article  PubMed  CAS  Google Scholar 

  9. Wilson C, Gupta R, Gilmour DG, Imrie CW (1987) Acute superior mesenteric ischemia. Br J Surg 74:279–281

    Article  PubMed  CAS  Google Scholar 

  10. Endean ED, Barnes SL, Kwolek CJ, Minion DJ, Schwarcz TH, Mentzer RM (2001) Surgical management of thrombotic acute intestinal ischemia. Ann Surg 233:801–808

    Article  PubMed  CAS  Google Scholar 

  11. Edwards MS, Cherr GS, Craven TE, Olsen AW, Plonk GW, Geary RL, Ligush JL, Hansen KJ (2003) Acute occlusive mesenteric ischemia: surgical management and outcomes. Ann Vas Surg 17:72–79

    Article  Google Scholar 

  12. Foley MI, Moneta GL, Abou-Zamzam AM, Edwards JM, Taylor LM, Yeager RA, Porter JM (2000) Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia. J Vasc Surg 32:37–47

    Article  PubMed  CAS  Google Scholar 

  13. Park WM, Gloviczki P, Cherry KJ, Hallett JW, Bower CT, Panneton JM, Schleck C, Ilstrup D, Harmsen WS, Noel AA (2002) Contemporary management of acute mesenteric ischemia: factors associated with survival. J Vasc Surg 35:445–452

    Article  PubMed  Google Scholar 

  14. ACC/AHA/ESC (2001) Guidelines for the management of patients with atrial fibrillation: executive summary. Circulation 104:2118–2150

    Google Scholar 

  15. Lange H, Jackel R (1994) usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. Eur J Surg 160:381–384

    PubMed  CAS  Google Scholar 

  16. Bradbury AW, Brittenden J, McBride K, Ruckley CW (1995) Mesenteric ischemia: a multidisciplinary approach. Br J Surg 82:1446–1459

    Article  PubMed  CAS  Google Scholar 

  17. Fock CM, Kulling P, Ranner G, Beaufort-Spontin F, Schmidt F (1994) Mesenteric arterial embolism: the value of emergency CT in diagnostic procedure. Eur J Radiol 18:12–14

    Article  PubMed  CAS  Google Scholar 

  18. Horton KM, Fishman EK (2001) Multi-detector row CT of mesenteric ischemia: can it be done? Radiographics 21:1463–147

    PubMed  CAS  Google Scholar 

  19. Serreyn RF, Schoofs PR, Baetens PR, Vandekerckhove D (1986) Laparoscopic diagnosis of mesenteric venous thrombosis. Endoscopy 18:249–250

    PubMed  CAS  Google Scholar 

  20. Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G et al (2006) Laparoscopy for abdominal emergencies: evidence based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 20:14–29

    Article  PubMed  CAS  Google Scholar 

  21. Anadol AZ, Ersoy M, Taneri F, Tekin E (2004) Laparoscopic Second-look in the management of mesenteric ischemia. Surg Laparosc Endosc Percutan Tech 14:191–193

    Article  PubMed  Google Scholar 

  22. Gegne D, Malay MB, Hogle NJ, Fowler DL (2002) Bedside diagnostic minilaparoscopy in the intensive care patient. Surgery 131:491–496

    Article  Google Scholar 

  23. Lobo Martinez E, Carvajosa E, Sacco O, Martinez Molina E (1993) Embolectomy in mesenteric ischemia. Rev Esp Enferm Dig 83:351–354

    PubMed  CAS  Google Scholar 

  24. Wadman M, Syk I, Elmstahl S (2000) Survival after operation for ischemic bowel disease. Eur J Surg 166:872–877

    Article  PubMed  CAS  Google Scholar 

  25. Williams LF (1988) Mesenteric ischemia. Surg Clin North Am 68:331–352

    PubMed  Google Scholar 

  26. Schneider TA, Longo WE, Ure T, Vernava AM (1994) Mesenteric ischemia: acute arterial syndromes. Dis Colon Rectum 37:1163–1174

    Article  PubMed  CAS  Google Scholar 

  27. Mamode N, Pickford I, Leiberman P (1999) Failure to improve outcome in acute mesenteric ischemia: seven year review. Eur J Surg 165:203–208

    Article  PubMed  CAS  Google Scholar 

  28. Kaleya RN, Sammartano RJ, Boley SJ (1992) Aggressive approach to acute mesenteric ischemia. Surg Clin North Am 72:157–182

    PubMed  CAS  Google Scholar 

  29. Mansour MA (1999) Management of acute mesenteric ischemia. Arch Surg 134:328–330

    Article  PubMed  CAS  Google Scholar 

  30. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD (2004) Acute mesenteric ischemia: a clinical review. Arch Intern Med 164:1054–1062

    Article  PubMed  Google Scholar 

  31. Klotz S, Vestring T, Rotker J, Schmidt C, Scheld HH, Schmid C (2001) Diagnosis and treatment of nonocclusive mesenteric ischemia after open heart surgery. Ann Thorac Surg 72:1583–1586

    Article  PubMed  CAS  Google Scholar 

  32. Brunaud L, Antues L, Collinnet-Adler S, Marchal F, Ayab A, Bresler L et al (2001) Acute mesenteric venous thrombosis: case for nonoperative management. J Vasc Surg 34:673–679

    Article  PubMed  CAS  Google Scholar 

  33. Levy P, Krausz MM, Manny J (1990) The role of second-look procedure in improving survival time for patients with mesenteric venous thrombosis. Surg Gynecol Obstet 170:287–291

    PubMed  CAS  Google Scholar 

Download references


The authors thank Dr. Bettina Hentschel (University of Leipzig) for assistance with the statistical analysis of the data.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Woubet T. Kassahun.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kassahun, W.T., Schulz, T., Richter, O. et al. Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review. Langenbecks Arch Surg 393, 163–171 (2008).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: