Acute Mesenteric Ischemia and Malpractice Claims

Fink, Sidney; Chaudhuri, Tuhin K.; Davis, Herbert H.

doi:10.1097/00007611-200002000-00012

Cited by 10 publications

(4 citation statements)

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“…There is paucity of data in the review of causes for AMI readmission. In fact, Fink et al 21 explored the malpractice claims due to late recognition of this disease entity, which is the most significant risk factor predicting mortality in this patient population. 19 Therefore, it is paramount to entertain this diagnosis in patients presenting to urgent facilities with abdominal pain that is out of proportion to physical examination.…”

Section: Discussionmentioning

confidence: 99%

Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival

et al. 2020

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Acute mesenteric ischemia (AMI) remains a vascular emergency. Our aim was to explore readmission for AMI. We identified all patients admitted for AMI from the state of California through the Healthcare and Utilization Project from 2005 to 2011. Our primary end point was the rate and etiology for readmission. Our secondary end points were the length of hospitalization and in-hospital mortality. Cox proportional hazard regression was utilized to assess risk of 30-day readmission. There were 534 (9.9%) readmissions at 30 days. The mean age was 67 ± 17 years and 209 (39.1%) were male. The five most common etiologies for readmission were AMI (7.6%), cardiac events (5.3%), severe sepsis (1.2%), dehydration (1.1%), and acute kidney failure (1.1%). Once readmitted, these patients were most likely to experience cardiac catheterizations (25.4%), red blood cell transfusions (23.6%), intubation and mechanical ventilation (17.6%), biopsy of the large intestine (13.9%), reoperation for small bowel resection (10.9%), administration of total parenteral nutrition (10.5%), and transfusion of other blood products (6.9%). This hospitalization was 8.8 ± 12.7 days long. In-hospital mortality was 36 patients (6.7%). On multivariable Cox-regression analysis, severe (hazard ratio [HR]: 2.1 [1.4–3.2], p = 0.0005) and moderate (HR: 1.5 [1.03–2.13], p = 0.04) Elixhauser Comorbidity Group, complications (HR: 1.5 [1.2–1.9], p = 0.0007), and longer index hospitalization (HR: 1.02 [1.01–1.02], p < 0.0001) were predictors of readmission. Conclusion AMI remains a vascular emergency. Readmissions have a significant rate of morbid invasive procedures and can lead to an in-hospital mortality of 6.7%. The adoption of guidelines similar to the European Society for Trauma and Emergency Surgery should be considered.

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Section: Discussionmentioning

confidence: 99%

Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival

et al. 2020

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“…Mucosal sloughing may cause bleeding into the gastrointestinal tract. At this stage, little abdominal tenderness is usually present, producing the classic intense visceral pain disproportionate to physical examination findings [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

A Strange Case of Left Bowel Ischemia after Right Hernioplasty

Geraci

Pisello

Modica

et al. 2010

Case Rep Gastroenterol

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We report the first observed case of a young man who suffered of large and unsuspected left bowel ischemia following an elective right open hernioplasty. A 54-year-old man had a 2-year history of right inguinal reducible mass and was admitted to hospital for an elective day case open inguinal hernioplasty for a direct right inguinal hernia. Apart from mild hypertension controlled with ACE inhibitor, he was medically fit and well. The patient was submitted to open tension-free mesh repair with polypropylene preshaped mesh with local infiltration anesthesia and additive sedation with midazolam. The local anesthesia and surgery were uneventful and he was discharged home on the same day as per day case protocol. He was readmitted about 12 h after discharge with a history of central and left lower abdominal pain with palpable mass, and distension and fever (38°C). After imaging and laboratory studies the patient was submitted to explorative surgery with the suspicion of left colonic ischemia. After intraoperative confirmation we performed standard left hemicolectomy. The postoperative course was uneventful; the patient was discharged in good general condition on the 7th postoperative day. Actually, the patient is in follow-up, with normal coagulation and hemochromocytometric pattern, asymptomatic for hypercholesterolemia and atrial flutter/fibrillation. Complications relating to bowel during open techniques of hernia repair are limited to two situations: the freeing of an incarcerated or strangulated segment of bowel and inadvertent laceration of large bowel in the presence of a sliding hernia. Following this strange case of colonic ischemia, a boolean Medline search (terms: hernia, complication, repair, groin, herniorrhaphy, hernioplasty, all major MESH subjects without language restriction) revealed no previous similar cases reported. However, to our knowledge, there is another trouble hypothesis: not causality but casualty. In conclusion, to our knowledge this is the first reported case of large left bowel ischemia following right open hernioplasty. We can conclude that the presence of a dolichocolon is an added risk factor for this rare and uneventful complication, but further investigations and case reports are necessary to estabilish the real causality.

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“…Paraneoplastic syndrome, where tumor causes compression and hypercoagulability, Infectious appendicitis and pancreatitis, venous trauma, and intraabdominal hypertension. 9,10 Risk factors…”

Section: Etiologymentioning

confidence: 99%

Acute Mesenteric Ischemi a (AMI): A surgical perspective

Shaikh¹,

Ali²,

Aftab³

et al. 2019

BIOMEDJ

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Acute mesenteric ischemia (AMI) is a rare surgical emergency as it involves perfusion and need frequent surgical interventions. It is a life threatening emergency with a poor prognosis. It is classified according to the etiological basis thromboembolism, non-obstructive and venous origin. AMI has various risk factors ranging from cardiac arrhythmias to the intraabdominal hypertension. Apart from the signs and symptoms, the multi-detector computer tomography remains a diagnostic tool with accuracy. In the management of AMI patients' initial resuscitation, hydration and analgesia play important role, however the operative /interventional management is either endovascular thrombectomy with or without stenting when there is no bowel involvement or peritonitis. The laparotomy with open vascular thrombectomy with vascular graft, it is indicated when bowel involvement and peritonitis patients. Often the whole bowel is gangrenous and no further treatment is needed because of certain mortality. The 2 nd step is to know the extent of bowel involvement meticulously and resection of bowel with necrosis or gangrene with anastomosis, further relook laparotomies and resection of the bowel may be need. Initially abdomen will be closed with Bagota bag or VAC (Vacuum Assisted Closed) dressing and final staged abdominal closer, once pathology resolves completely. As far as prevention of all types

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Acute Mesenteric Ischemia and Malpractice Claims

Cited by 10 publications

References 0 publications

Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival

Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival

A Strange Case of Left Bowel Ischemia after Right Hernioplasty

Acute Mesenteric Ischemi a (AMI): A surgical perspective

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