Document Detail

Visceral ischemia after cardiopulmonary bypass.
MedLine Citation:
PMID:  10917470     Owner:  NLM     Status:  MEDLINE    
The diagnosis and management of gastrointestinal complications associated with cardiopulmonary bypass is often hindered by a complicated clinical picture and equivocal examination. To better define the incidence, risk factors, and mortality, we reviewed the records of all patients undergoing cardiopulmonary bypass from 1988 through 1996. The database for this study comprised 14,521 patients who underwent cardiac surgery. The patients (543) with gastrointestinal complications were identified, and those with major complications (166) were individually reviewed. Major complications included pancreatitis, gastritis, laparotomy, gastric ulcer, cholecystitis, colonic perforation, gastrointestinal bleeding, diverticulitis, bowel obstruction, perforation, and visceral ischemia. Our results were the following. 1) Gastrointestinal complications were noted in 3.7 per cent (543) of patients with major complications occurring in 1.2 per cent. In 166 patients, 187 major complications were noted. 2) Visceral ischemia, an infrequent but usually fatal (71%) complication, occurred in 24 (0.17%). 3) Of the ischemic events, 83 per cent (20 of 24) affected the bowel; with the colon involved 80 per cent of the time (16 of 20). 4) Patients with visceral ischemia were more likely to be female (relative risk 2.1), have longer pump times (92.2 versus 74.2), have cardiac procedures other than coronary artery bypass graft (relative risk 2.6), and have end-stage renal disease (relative risk 16.7). We conclude that, given the incidence and mortality related to visceral ischemia, especially to the colon, patients with risk factors (end-stage renal disease, female sex, non-coronary artery bypass graft, and longer pump times) should undergo routine endoscopic examination of the colon early after bypass and when clinically indicated thereafter.
T Fitzgerald; D Kim; S Karakozis; H Alam; H Provido; J Kirkpatrick
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  66     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-08     Completed Date:  2000-08-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  623-6     Citation Subset:  IM    
Department of Surgery, Washington Hospital Center, DC 20010, USA.
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MeSH Terms
Cardiopulmonary Bypass / adverse effects*,  mortality
Colon / blood supply*
Ischemia / etiology*
Medical Records
Middle Aged
Retrospective Studies
Risk Factors
Viscera / blood supply*

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