Challenges Encountered during the Treatment of Acute Mesenteric Ischemia

Abstract

Introduction. Acute mesenteric ischemia, although rare, is associated with numerous complications and death. This work presents acute mesenteric ischemia treatment based on an analysis of various management strategies and identifies prognostic factors that influence therapy effectiveness. Material and Methods. We conducted a retrospective analysis of all patients who were diagnosed with acute mesenteric ischemia due to occlusion and hospitalized between January 1, 2002, and December 31, 2018. Results. Acute ischemia of the bowel mesentery was diagnosed in 41 patients (27 women and 14 men; mean age, 65.4 years). All patients underwent laparotomy. For 13 (31.71%) patients, surgery was performed within the first 24 hours of the clinical symptom onset. Mesenteric artery embolectomy without intestine resection was performed for 7 (17.07%) patients. Partial intestine resection due to necrosis was performed for 21 (51.22%) patients. Exploratory laparotomy without a therapeutic procedure was performed for 13 (31.71%) patients. Fifteen (36.59%) patients were discharged home in good general condition. Twenty-six (63.41%) patients died. The time from the clinical symptom onset until intervention exceeded 24 hours for all patients who died. Surgery within the first 24 hours reduced mortality associated with acute mesenteric ischemia (P=0.001). Female sex, age older than 65 years, obesity (body mass index>30), diabetes, chronic kidney disease, and smoking were adverse prognostic factors for increased mortality for patients with acute bowel ischemia. Conclusion. The time from clinical symptoms to acute mesenteric ischemia treatment was the main prognostic factor and helped determine appropriate management. Early diagnosis and rapid intervention improved treatment outcomes and survival.

Intestinal Ischemia Due to Mesenteric Vascular Thrombosis in a Patient with Positive SARS-Cov-2 RNA without Primary Pulmonary Symptom: A Case Report

“… 13 We distinguished occlusive and non-exclusive types of acute ischemia of the bowel mesentery supported their cause. 14 Occlusive causes of acute mesenteric ischemia include mesenteric artery embolism (50% of cases), mesenteric artery thrombosis (15-25%), and celiac vein thrombosis (5-15%). 15 …”

Superior mesenteric artery thrombosis and small bowel necrosis: An uncommon thromboembolic manifestation in COVID-19 pneumonia

“…Mesenteric ischemia is an abdominal emergency that carries high morbidity and mortality rates [ 22 ]. Vascular surgical intervention is the treatment of choice and should be performed within 12 hours of symptoms before bowel gangrene to occur [ 23 ]. Unfortunately, patients with COVID-19 often manifest late due to ambiguity of symptoms and predominance of respiratory manifestations [ 15 ].…”

“…Findings of bowel necrosis on imaging such as pneumatosis without clinical manifestation of peritonitis would be considered for exploratory laparotomy. Endovascular thrombectomy or embolectomy procedures should be preserved for patients without evidence of bowel ischemia or clinical manifestation of peritonitis [ 23 ].…”

Superior Mesenteric Artery Thrombosis in COVID-19 Pneumonia: an Underestimated Diagnosis—First Case Report in Asia

“…It can impact the microcirculatory dysfunction and possibly decrease organ damage. However, the appropriate dose in COVID is still a matter of ongoing research [7]. It is prudent to monitor prothrombin time, platelet count, and D-dimer concentrations in severe COVID-19 infection.…”