Acute Mesenteric Ischemia

ABSTRACT

PURPOSE: Clinical manifestations of acute mesenteric ischemia (AMI) may be nonspecific and early diagnosis is difficult. Despite advances in diagnostic and surgical techniques, AMI is still associated with high morbidity and mortality due to delayed diagnosis. METHODS: To analyze the causes, diagnosis, and treatment of AMI, as well as the factors affecting prognosis, we retrospectively reviewed 32 patients treated for AMI between 1980 and 2002. RESULTS: There were 19 men and 13 women. The mean age was 61.5+/-15.5 years. The average duration of symptoms was 50.3 hrs (2~168). AMI presented as abdominal pain in 30, and other symptoms included vomiting, hematochezia, and melena. The most commonly associated medical condition was heart disease (valvular disease, arrhythmia, etc.). For diagnosis, conventional angiography was performed in 6, CT in 14 and exploratory surgery in 14. The predictive value of angiography and CT was 100% and 85.7%, respectively. The causes of ischemia were SMA embolism in 11, SMA thrombosis in 8, SMV thrombosis in 7, non-occlusive in 2 and indeterminate in 4. Thirty patients underwent operation. At initial operation, bowel resection was performed in 26 and thromboembolectomy only in 2. Second-look operation was performed in 4. Two patients received radiological interventional treatment; one with urokinase and the other with papaverine. Of 19 arterial ischemia, 6 patients received long term anticoagulation, whereas all 7 patients with SMV thrombosis received long term anticoagulation. The mean F/U was 27.4 mons (1~131). Complications occurred in 16 (53.3%), wound infection in 6, sepsis in 5, short bowel syndrome in 4 and anastomoticsite leakage in 2. Mortality associated with operation occurred in 7 (23.3%). The patients aged over 65 years and with postoperative complication showed higher mortality. CONCLUSION: When mesenteric ischemia is suspected, early CT or angiography and an appropriate surgical approach should be performed to improve the prognosis.