A Clinical Review of Acute Mesenteric Ischemia

ABSTRACT

PURPOSE: Acute mesenteric ischemia (AMI) is difficult to diagnose and has a high rate of complications as well as a high mortality rate. The aim of this study was to define the risk factors and mortality rate of patients with acute mesenteric ischemia. METHOD: We retrospectively reviewed 18 patients with acute mesenteric ischemia at the Kangbuk Samsung Hospital from June 1995 to May 2006. RESULT: The mean age was 51.1 (age range, 27 to 78 years) and the gender ratio was 21 (male, 18, female, 6). The most common underlying diseases were hypertension (50%, n=9), diabetes mellitus (44.4%, n=8), artrial fibrillation (22%, n=4), and congestive heart failure (11%, n=2). Abdominal pain was the most frequent presenting symptom; other symptoms included nausea, vomiting and hematochezia. To confirm the diagnosis, a CT was performed in 10 cases, a CT and angiography was performed in four cases, and exploratory surgery in four cases. The causes of the acute mesenteric ischemia were SMA embolism in eight cases (44%), SMA thrombosis in 5 cases (27%), SMA with IMA thrombosis in 1 case (5%), IMA thrombosis in 1 case (5%), SMV thrombosis in 2 cases (11%), and SMV with IMV thrombosis in 1 case (5%). All of the patients underwent abdominal exploration, 16 cases had bowel resection performed, one case had a thromboembolectomy performed, and one case was opened and closed. Complications occurred in nine (50%) patients. Sepsis in three, wound infection in three, short bowel syndrome, toxic hepatitis, pulmonary embolism, and ischemic heart disease also occurred. The overall mortality rate was 33.3% (6 cases). The mortality rate with a SMA embolism was 5% (1 case), with SMA thrombosis was 40% (2 cases), with SMA+IMA thrombosis was 100% (1 case), in IMA thrombosis 100% (1 case), in SMV thrombosis was 0%, and 100% in SMV+IMV thrombosis. CONCLUSION: Despite the low incidence of acute mesenteric ischemia, it is still a life-threatening condition. Thus, when mesenteric ischemia is suspected, early diagnosis, with CT or angiography is required, and thrombolytics and surgery should be considered to improve the prognosis.