Cor Vasa 2010, 52(4):252-256 | DOI: 10.33678/cor.2010.061

Acute occlusion of the splanchnic vascular bed after cardiac surgery

Martin Varga^1,*, Ivan Matia¹, Miloš Kučera¹, Bedřich Sixta¹, Matěj Kočík¹, Martin Oliverius¹, Jan Pirk², Miloš Adamec¹

¹ Klinika transplantační chirurgie, Institut klinické a experimentální medicíny, Praha

² Klinika kardiovaskulární chirurgie, Institut klinické a experimentální medicíny, Praha, Česká republika

Aim: To retrospectively assess the incidence, selected risk factors, clinical, imaging, and laboratory signs of vascular artery involvement in patients undergoing cardiac surgery in the Prague-based Institute for Clinical and Experimental Medicine (IKEM) and requiring subsequent surgery.

Materials and methods: In the period from 1 January 2003 through 31 April 2009, a total of 7,971 cardiac surgical procedures were performed at the Department of Cardiovascular Surgery, IKEM. Within 30 days postoperatively, 26 patients experienced acute abdominal pain requiring revision surgery. The cause of abdominal pain was acute occlusion of the splanchnic vascular bed in nine patients (35%).

Results: The clinical signs of ischemia in patients undergoing cardiac surgery were not dramatic. Hypotension, abdominal pain and distension, and circulatory support with catecholamines were present in 80% of patients. Major laboratory findings included elevated levels of C-reactive protein (median, 200 mg/l) and a white blood cell count (median, 17.5×109/l). The specificity and sensitivity of imaging methods in diagnosing intestinal ischemia were low. Six patients died postoperatively (66%).

Conclusion: While a rare diagnosis, acute occlusion of the splanchnic vascular bed following cardiac surgery is associated with high morbidity and mortality. Both imaging methods and laboratory values have low sensitivity and specificity and are not helpful in establishing early diagnosis. The only right road to a correct diagnosis includes repeated assessment of the patient's clinical status and its development by an experienced surgeon; early revision surgery, if necessary, gives the patients a chance to survive.

Keywords: Mesenterium; Vascular occlusion; Complications; Cardiac surgical procedures

Published: April 1, 2010  Show citation