Retrospective Study of Outpatient Treatment of Acute Mesenteric Circulatory Disorders

Abstract

Introduction. Acute violation of mesenteric blood circulation is one of the most severe urgent diseases of the abdominal cavity. The number of patients, and the mortality rate resulted from this pathology, is steadily increasing every year. The number of patients has only increased during the pandemic of new coronavirus infection COVID-19.The aim of study was to develop options to prevent severe outcomes of this pathology at the pre-hospital stage identifying patients with high risk of developing mesenteric thrombosis.Materials and methods. The study was a retrospective analytical study that included 279 (100%) patients and their outpatient records. All patients were diagnosed with acute mesenteric circulation disorder and treated at the hospital surgery clinic in Smolensk in 2013-2020. When conducting a thorough analysis of patients findings, special attention was paid to: past medical history, in particular, the presence of abdominal pain syndrome, features, localization and intensity of pain; the nature of labour activity during life; existing comorbidity; surgical interventions of the abdominal organs, objective examination findings, and laboratory and instrumental test findings. The data obtained were processed using methods of statistical analysis described in the book "Statistics in biology and medicine" by Medik V.A., Tokmachev M.S., Fishman B.B. (2001), and MS Excel 2019.Results. A retrospective analysis revealed that 63 (22.5%) patients had a burdened anamnesis of acute mesenteric circulatory disorders in close relatives. An increased number of "bad" lipoproteins of low and very low density was noted, this being an unfavorable factor in the development of atheromatous lesion of the mesenteric vascular bed followed by the manifestation of acute mesenteric circulatory disorders. The analysis revealed a group of patients with ischemic colitis that included 139 patients (49.1 %). The diagnosis was supported by fibrocolonoscopy. In addition, it was found that 4 0.7 years (from 3 to 4.5 years) passed from the onset of symptoms to hospitalization for acute mesenteric circulatory disorders in patients with abdominal symptoms.Conclusions. All patients with acute mesenteric circulatory disorders had manifested clinical signs of the disorder 3-4.5 years before it was diagnosed; this allowed suspecting violations along the mesenteric bed. Patients with a burdened anamnesis of the cardiovascular system (coronary heart disease-93.7%, arterial hypertension 86.1%, various forms of atrial fibrillation 83.4%) were mostly at risk. Identification of a risk group at the outpatient stage for potential occurrence of acute mesenteric circulatory disorders can help reduce incidence of this pathology.