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.
ABSTRACT
OBJECTIVE: Despite increased awareness of the fatality of mesenteric ischemia, the diagnosis seldom is made prior to the onset of gangrene. The multiplicity of etiologic factors, the many varied presentations, and splanchnic vasoconstriction all affect the extent of ischemic injury, adding to the complexity of the clinical problem. Extensive acute processes are still catastrophic illnesses with a high mrotality, but there is a potential for both better diagnisis and therapy with an improved outcome. Discussion of the pathophysiology, diagnosis, and treatment of this entity will be presented. METHODS: A Retrospective review of our experience with ischemic bowel disease was made. Ten consecutive clinical cases admitted in ChungNam National University Hospital from October 1990 to April 1994 were observed. RESULTS: 1) We experienced 5 patients with arterial embolic occlusion, 1 patient with venous thrombosis and 4 patients with colonic ischemia. 2) The peak ages were 6th decade and 8th decade. 3) The major clincal symptoms and signs were abdominal pain (100%), abdominal tenderness (70%), melena (70%), nausea (60%), fever (50%), vomiting (40%) and abdominal distension (30%). 4) On laboratory findings, there were leukocytosis (80%) and thrombocytopenia (20%) 5) In plain film, there were ileus (70%), edematous intestinal wall (50%), mucosal edema (30%), thumb printing (10%) and gasless abdomen (10%). Among the 5 cases performed abdominal CT, there were thickening of intestinal wall in 4 cases, narrowing of intestinal lumen in 2 case and ascites in 3 cases. 6) Bowel resections were perfomed in 7 cases and supportive care was performed in 3 cases. 7) The overall mortality rate was 30%, CONCLUSION: An oggressive approach in patients suspected of having ischemic bowel is indicated if the diagnosis is to be made before necrosis has occurred. A high index of suspicion, early angiography, correction of the underlying cardiac disease, treatment of splanchnic vasoconstriction, surgical revascularization, and resection of gangrenous bowel are necessery if there is to be a significant reduction in the high mortality rates associated with mesenteric ischemia.