Acute intestinal ischemia—a rare and underestimated
complication in thermally injured patients
Received: 26 January 2009 / Accepted: 14 December 2009 / Published online: 23 January 2010
Abstract Acute intestinal ischemia represents a rare but
often fatal disease. In retrospective analysis, up to 86% with
this complication had a prior history of cardiovascular
disease (Irvinen et al. Ann Chir Gynaecol 83:22-25, 1994).
It is also a rare but well-known complication in severe
thermally injured patients. Here, we describe our experi-
ence with this disease in our critically ill patients suffering
from acute thermal injury. In a retrospective analysis of
634 patients who were treated at our burn care center,
three patients were identified with intestinal ischemia.
Two patients with non-occlusive disease during continu-
ous veno-venous hemofiltration died, while one patient
with arterial embolism in a superior mesenteric artery
branch survived. Acute intestinal ischemia is a severe and
life-threatening complication in thermally injured patients.
It can occur even days after the acute trauma and
diagnostic criteria are often insecure.
Keywords Burn injury
Gastrointestinal complications are a common problem in
severely burned patients. Reported complications include
paralytic ileus, gastrointestinal tract bleeding, gastric ulcers
and acute necrotizing cholecystitis. Although there are no
exact data concerning the frequency and outcome of acute
necrotizing intestinal ischemia in severe-burned patients, it
is a well-known complication in specialized burn centers
. In general, the most common causes for acute intestinal
ischemia include arterial embolism, arterial thrombosis,
venous thrombosis and non-occlusive disease [2, 21]. The
overall survival rate differs between 81% and 34% [2–8].
The therapy aims at arterial re-perfusion of life-threatening
intestinal regions and resection of necrotic tissue.
We report of three out of 634 patients who were treated
at our burn care center, being identified clinically to have
intestinal ischemia. The symptoms in these patients occur in
different phases during hospitalization with different dis-
A 45-year-old male patient attempted suicide by setting
alight with gasoline. He suffered II° and III° facial and
cervical burn injuries. Additionally, burn injuries were
found on his chest, both arms, hands and abdomen. The
total burn surface area (TBSA) was 37% including
inhalation trauma, his ABSI-score was 10. Since 1974, he
suffered from depression after a car accident with a
craniocerebral injury. The patient received standard proto-
col treatment with initially escharotomy for III° burn
injuries on his ventral chest and both upper extremities.
Due to highly elevated myoglobin-levels and elevated
creatinine-levels we started continuous veno-venous hemo-
filtration (CVVH) on the day of admission until day 25.
Four days after injury, the patient was stable enough for
surgery: in five operations, the necrotic tissue was excised
followed by the application of split skin mesh grafts. After
day 36, he was allowed to breathe spontaneously. Until day
47, the patient was well, he was fed orally without
problems, he had normal bowel movements, his serum
F. Siemers (*)
Plastic- and Hand Surgery, Burn Unit,
University Clinics Schleswig-Holstein,
23538 Lübeck, Germany
Eur J Plast Surg (2010) 33:79–82