ABSTRACT
Acute mesenteric ischemia [AMI] is a morbid condition with a difficult diagnosis and a high rate of complications, which is associated with a high mortality rate. For the evaluation of the hospital results of diagnosis and treatment of acute mesenteric ischemia we reviewed our experience. The clinical data of 24 patients diagnosed with acute mesenteric ischemia between 2001 and 2004 were reviewed, assessed and hospital results analyzed. The dominant population were males [83%] whereas females were only [17%]. The median age was 61.5, and cases increased with age. Smoking had been studied as a causative factor for acute mesenteric ischemia. 18 patients in the study were regular smokers [75%]. 22 patients [92%] had previous medical or surgical problems, and the most frequent were respectively heart disease [62%], recent surgical procedures [26%], DM [13%], CVA [11%], and previous digestive problems [11%]. 11 patients [46%] had previous thrombosis events. 6 patients [25%] had recent stress [acute illness] associated with mesenteric ischemia. The most common symptoms and signs were respectively: abdominal pain [91%], nausea and vomiting [79%], intestinal obstrucion [58%], gastrointestinal bleeding [33%]. The Median time of pain was 45.6 h, and the most frequent duration was 24 h and less. Abdominal distension was the the most frequent sign [71%], followed by peritoneal irritation [58%]. On ECG series at the time of admission an Atrial Fibration was found in 33% of cases, heart ischemia signs in 66, 67% of cases, enlargment of heart in 17.5%, and arrhythmias in 17.5%. 11 patient [45%] had problems of the chest at the time of admission, and [96%] had cardiopulmonary problems. laboratory findings were non-specific, and the most important signs were:- increased WBC, and the mean value was 18604 mm3-decreased blood PH, and the mean value was 7.2. -the other findings were not helpful in diagnosing acute mesenteric ischemia. Abdominal scanning by AXR and U/S were not helpful and showed some non-specific finding. Angiography was not performed for any cases. CT scan was performed in 6 cases of those had high suspision of acute mesenteric ischemia, 3 of them were diagnosed [and included in this study], it showed specific signs [embolism] in 2 patients [8%], nothing in one case [4%]. The predictive value, sensitivity, and specificity were 67%, 67%, 67%, respectively. All patients underwent open surgery [100%] without any case of laparoscopic, and the indications were: explorative laparotomy [7 cases] 29%, intestinal obstruction [2 cases] 8%, peritoneal irritation [14 cases] 59%, fecal fistula after previous surgery [1 case] 4%. The surgery was performed after admision 31 h as a mean. Surgery showed that there is one or more foci of gangrenous lesions in all patient [100%], these lesions were supplied by SMA in 23 cases [96%], and 1 case was supplied by IMA. and the median leangth of its was 282 cm. Selected procedure to the gangrenous intestine was done in 21 cases [87%], which was colointestinal resection with primary anastomosis in 19 cases and with stoma in 2 cases, while only 2 patient [8%]underwent revascularization procedures [thromboembolectomy] Secound operation was done in 3 cases [12.5%], the indication was fecal fistula [2 cases] and intestinal obstruction [1 case]. The cause of occlusion was determined by clinical and imaging study and the results: 19 cases [79%] were arterial occlusion [14 cases [58%] embolism, and 5 cases [21%] thrombosis], 3 cases [13%] were mesenteric venous thrombosis, and 2 cases [8%] were non-occlusive mesenteric ischemia [NOMI]. Mortality associated with surgery was 14 cases [58%], and higher mortality rate occured in:-Mesenteric venous thrombosis patients [67% of this group], arterial thrombosis [60%], and embolism [5 7%]-At the group of late surgery-The patient at advanced age-Patients having recent heart or chest problems. Most cases of death were at the first 24 h after operation, and less by the time. Multiorgan failure [MOF] was the most frequent cause of death in this group of patients [71.5%], then hemorrhagic shock [2 1%], then heart failure [7%]. Complications occurred in 14 cases of total amount of patient [58%], and in 8 of surviving patients [80%]. -The complications in survived cases were: wound infection in [2], sepsis in [3], gastrointestinal bleeding in [1], short bowel syndrome in [2], bowel obstruction in[1], faecal fistula in [I], multiorgan failure in 2. Total Parenteral nutrition [TPN] was necessary in 60% of survived patients