Mesenteric Ischemia – Outcome after Surgical Therapy in 83 Patients

Abstract

Background: Intestinal ischemia is the prime vascular emergency for the visceral surgeon. However, the diagnosis of mesenteric ischemia is difficult, the surgical options are often limited and the overall outcome is generally poor. Methods: We report on a single center series of 83 patients undergoing surgery for mesenteric ischemia during a 3-year period. Risk factors, clinical presentation, type and timing of imaging studies and their implications for surgical therapy and outcome are analyzed. Results: Hypertension and diabetes were the most common risk factors (68/64% of all patients). Abdominal pain was the most general symptom upon presentation to the surgical unit (73%). Two-phase, contrast-enhanced computed tomography was applied as the standard preoperative imaging modality (correct diagnosis in 69%). Bowel resections were necessary in most patients; approaches to restore blood flow by vascular surgery interventions were applied in 17 patients (20%). The overall morbidity and mortality rate in our study cohort was expectedly high (59% 1 month mortality). Conclusion: The diagnosis and surgical treatment of mesenteric ischemia remains a major difficulty. We recommend preoperative CT analysis followed by an aggressive indication for early surgical exploration and bowel resection. An attempt of revascularization is justified for selected patients with limited macrovascular disease.

Editorial on “enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2)”

“…A previous study by the same group reported an increase mortality rate in patients with shock in the presence of renal, and liver failure who received early EN (11). The mortality rate of mesenteric ischemia in this trial was 75% which is in line with other reported series (22)(23)(24).…”

Prognostic value of multidetector computed tomography in bowel infarction

“…This unsatisfactory result is related to different factors, among which the most important are the patient's clinical history, the aetiology of the intestinal ischaemia and the degree of anatomical damage at the time of diagnosis. Clinically, the most important factors in evaluating prognosis are the following: arterial hypertension, diabetes mellitus, age, smoking history, family history of heart disease, peripheral and/or cerebral vascular disease, coronary disease, symptoms of chronic mesenteric ischaemia, heart failure, renal failure, previous myocardial infarction, previous surgery, chronic obstructive pulmonary disease, hypercholesterolaemia, atrial fibrillation, time elapsed between diagnosis and treatment, duration of symptoms, surgical treatment of the acute event and levels of metabolic acidosis [12][13][14][15][16].…”

“…In this regard, as previously stated cardiaco, insufficienza renale, precedente infarto miocardico, precedente intervento chirurgico, broncopatia cronica ostruttiva, ipercolesterolemia, fibrillazione atriale, intervallo di tempo intercorso tra diagnosi e terapia, durata dei sintomi, trattamento di tipo chirurgico dell'evento acuto e livelli di acidosi metabolica [12][13][14][15][16].…”

Intestinal ischemia: current treatment concepts

“…Frequently, patients with AMI are elderly and often suffer from cardiovascular diseases like ischemic heart disease, cardiac insufficiency, atrial fibrillation, hypertension, or peripheral vascular disease [8]. Other important risk factors are CMI and previous cardiac or vascular surgery [9].…”