Retrospective study of mesenteric ischemia

Authors

  • Mallikarjuna Reddy Mandapati Department of General Surgery, NRI General Hospital, Chinakakani, Guntur, Andhra Pradesh, India
  • Sanjeev Kumar Jukuri Department of General Surgery, NRI General Hospital, Chinakakani, Guntur, Andhra Pradesh, India
  • Nageswara Rao Nasika Department of General Surgery, NRI General Hospital, Chinakakani, Guntur, Andhra Pradesh, India
  • Haleema Neshat Department of General Surgery, NRI General Hospital, Chinakakani, Guntur, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20203232

Keywords:

Mesenteric embolism, Mesenteric infarction, Mesenteric ischemia, Mesenteric thrombosis

Abstract

Background: Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes.

Methods: A monocentric retrospective study was conducted between 01 August 2013 and 31 December 2019; 24 AMI patients underwent surgery (17 men and 7 women). Retrospectively, the risk factors, management until diagnosis and mortality were evaluated.

Results: Patients present with an acute pain of the abdomen. Diagnosis was provided by CT with contrast medium. The 30-day mortality was 45.8%, the late mortality was 25% and the overall mortality was 70.8%. For the <12 hours delay group, the mortality was 33.3%, and the mortality in the group with 12-24 hours delay was 80% and was 87.5% in the >24 hours after admission group.

Conclusions: If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.21% of all acute surgical admissions.

References

Acosta S. Mesenteric ischemia. Curr Opin Crit Care. 2015;21:171-8.

Clair DG, Beach JM. Mesenteric ischemia. N Engl J Med. 2016;374:959-68.

Kärkkäinen JM, Acosta S. Acute mesenteric ischemia (part I)- incidence, etiologies, and how to improve early diagnosis. Best Pract Res Clin Gastroenterol. 2017;31:15-25.

Aschoff AJ, Stuber G, Becker BW, Hoffmann MH, Schmitz BL, Schelzig H, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdomin Imag. 2009;34:345-57.

Moore HB, Moore EE, Lawson PJ, Gonzalez E, Fragoso M, Morton AP, et al. Fibrinolysis shutdown phenotype masks changes in rodent coagulation in tissue injury versus haemorrhagic shock. Surgery. 2015;158:386-92.

Carver TW, Vora RS, Taneja A. Mesenteric ischemia. Crit Care Clin. 2016;32: 155-71.

Park WM, Gloviczki P, Cherry KJ Jr, Hallett JW Jr, Bower TC, Panneton JM, et al. Contemporary management of acute mesenteric ischemia: Factors associated with survival. J Vasc Surg. 2002;35:445-52.

Kougias P, Lau D, El Sayed HF, Zhou W, Huynh TT, Lin PH. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg. 2007;46:467-74.

Nuzzo A, Maggiori L, Ronot M, Becq A, Plessier A, Gault N, et al. Predictive factors of intestinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center. Am J Gastroenterol. 2017;112:597-605.

Wilson C, Imrie CW. Amylase and gut infarction. Br J Surg. 1986;73:219-21.

Bradbury AW, Brittenden J, McBride K, Ruckley CV. Mesenteric ischaemia: a multidisciplinary approach. Br J Surg. 1995;82:1446-59.

Kassahun WT, Schulz T, Richter O, Hauss J. Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review. Langenbeck's Arch Surg. 2008;393:163-71.

Aliosmanoglu I, Gul M, Kapan M, Arikanoglu Z, Taskesen F, Basol O, et al. Risk factors effecting mortality in acute mesenteric ischemia and mortality rates: a single centre experience. Int Surg. 2013;98:76-81.

Kellow ZS, MacInnes M, Kurzencwyg D, Rawal S, Jaffer R, Kovacina B, et al. The role of abdominal radiography in the evaluation of the non-trauma emergency patient. Radiology. 2008;248:887-93.

Klar E, Rahmanian PB, Bücker A, Hauenstein K, Jauch KW, Luther B. Acute mesenteric ischemia: a vascular emergency. Deutsches Arzteblatt Int. 2012;109(14):249-56.

Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology. 2003;229:91-8.

David RA, Erben Y, Kalra M. Clinical presentation, etiology, and diagnostic considerations. In: Oderich G, editor. Mesenteric Vascular Disease. New York: Springer; 2015:199-209.

Acosta S. Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion. World J Gastroenterol. 2014;20:9936-41.

Hmoud B, Singal AK, Kamath PS. Mesenteric venous thrombosis. J Clin Exp Hepatol. 2014;4:257-63.

Lilley EJ, Cooper Z, Schwarze ML, Mosenthal AC. Palliative care in surgery: defining the research priorities. J Palliat Med. 2017;20:702-9.

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Published

2020-07-23

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Original Research Articles