A study on 107 patients with acute mesenteric ischemia over 30 years

Abstract

Acute mesenteric ischemia (AMI) is a life threatening cause of acute abdomen. The purpose of this study is to define risk factors that predict the adverse outcome of AMI and to present our experience in the last 30 years. Hospital records and clinical data of 107 patients undergoing surgical intervention for AMI during the last 30 year period were reviewed and clinical outcomes as well as factors influencing mortality were analyzed. Mesenteric arterial thrombosis, arterial embolism and nonocclusive mesenteric ischemia (NOMI) were the cause of AMI in 68 (63.6%), 28 (26%), and 11 patients (10.2%), respectively. Abdominal pain was the most common presenting symptom (90.6%). Peritonitis was observed in 96 patients (89.7%) and 24 patients (22.4%) were in shock. Abdominal ultrasonography was performed in 46 patients (42%), abdominal CT angiography in 36 patients (33%) and mesenteric angiography in 12 patients (10.5%). All patients were operated and 11 (10%) patients underwent a second-look operation. Bowel resection was necessary in 101 patients (93.4%) during the initial operation and in seven patients (6.5%) during the second-look operation. The hospital mortality was 55.1%. Mortality was mainly due to multiorgan failure (43%). Diabetes mellitus, use of digoxine and antiplatelet drugs, duration of the symptoms until before surgery, existence of shock, low levels of the pH and bicarbonate and re-laparotomy were found to be negative predictors of the perioperative mortality. The use of total parenteral nutrition and CT angiography was found to be a protective factor against mortality. A high index of suspicion with prompt diagnostic evaluation with CT angiography may reduce time prior to surgical intervention which may lead to improved patient survival.

Prognostic factors in patients with acute mesenteric ischemia

“…A large majority of these studies, like ours, have a retrospective design (14,15). The absence of a specific method for the diagnosis of AMI generally results in delayed diagnosis.…”

“…Fluid resuscitation, invasive hemodynamic monitoring, prophylactic antibiotherapy, systemic anticoagulation, resection of ischemic and necrotic intestinal loops, restoration of blood supply, consideration of short bowel syndrome in terms of remaining intestine length, and critical intensive care are all essential components of treatment (14). The operative technique performed is directly related to the affected intestinal loop, and the extent of involvement has been reported to effect mortality.…”

Emergent Surgical Resection for Acute Mesenteric Ischemia - An ACS-NSQIP Analysis from 2005 to 2013

“…A 2012 analysis by Alhan et al revealed a hospital mortality rate of 55.1%. Diabetes, digoxin and antiplatelet therapy, prolonged symptom duration, shock, acidosis, and re-laparotomy were all negative predictors of mortality 5 . ACS-NSQIP is the first nationally validated, riskadjusted, outcomes-based program to measure and improve the quality of surgical care.…”

Imaging of acute superior mesenteric artery embolus using spectral CT in a canine model

“…1 Since the affected site, range and severity varies, AMAE has complex and variable clinical symptoms and signs, laboratory tests and imaging manifestations, and its early diagnosis is very difficult because of overlapping manifestations with primary diseases. 2,3 Recent great advances in multislice CT (MSCT) have encouraged research into the diagnosis of AMAE.…”