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February 1965

Serial Epidural Analgesia in Mesenteric Arterial Failure

Arch Surg. 1965;90(2):177-181. doi:10.1001/archsurg.1965.01320080001001

THE DIFFICULT recovery of some surgical patients in the older age group may stem from an ineffective mesenteric arterial circulation. Clinically, acute intestinal ischemia is characterized by prostration and intestinal irritation evolving within the first 24 hours after operation. The patient describes harsh, unrelenting, abdominal cramps. Usually, urgent defecation is a salient companion. The blood pressure in the upper extremities frequently falls within normal range but is often lower than preoperative recordings. If this pattern persists without improvement, the victim may develop unresponsive hypotension and succumb to widespread but discontinuous focal hemorrhagic necrosis of the intestinal tract. On occasion, hemorrhagic necrosis involves the liver and spleen implying restricted perfusion in multiple organs of the splanchnic bed. No organic occlusion of major channels can be uncovered at operation or autopsy.3,6 Surgical trauma superimposed on a waning cardiac potential and defective pulmonary exchange appears to account for signal modifications in blood

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