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Acute occlusive mesenteric ischemia: surgical management and outcomes
Matthew S Edwards1, Gregory S Cherr, Timothy E Craven
1Division of Surgical Sciences, Section on Vascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Abstract:
Acute mesenteric ischemia secondary to arterial occlusion (AMI) remains a highly lethal condition. To examine recent trends in management and associated outcomes, we examined our institutional experience over a recent 10-year period. All patients treated for AMI between January 1990 and January 2000 were identified (76 patients, 77 cases) and their medical records examined. At presentation, 64% demonstrated peritonitis and 30% exhibited hypotension. The interval from symptom onset to treatment exceeded 24 h in 63% of cases. Etiology was mesenteric thrombosis in 44 patients (58%) and embolism in 32 patients (42%). Thirty-five patients (46%) had prior conditions placing them at high risk for the development of AMI including chronic mesenteric ischemia (n = 26) and inadequately anticoagulated chronic atrial fibrillation (n = 9). Surgical management consisted of exploration alone in 16 patients, bowel resection alone in 18 patients, and revascularization in 43 patients, including 28 who required concomitant bowel resection. Overall, intestinal necrosis was present in 81% of cases. Perioperative mortality was 62% and long-term parenteral nutrition (TPN) was required in 31% of survivors. Peritonitis (odds ratio [OR] 9.4, 95% confidence interval [CI] 1.6, 54.0; p = 0.012 and bowel necrosis (OR 10.4, CI 1.9, 56.3; p = 0.007) at presentation were independent predictors of death or survival dependent upon TPN. We conclude that AMI remains a highly lethal condition due in large part to advanced presentation and inadequate recognition and treatment of patients at high risk.
Insights
Acute mesenteric ischemia (AMI) is a deadly condition. Delayed treatment and presentation with peritonitis or bowel necrosis significantly increase mortality risk in AMI patients.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Abdominal Medicine
Background:
- Acute mesenteric ischemia (AMI) secondary to arterial occlusion is a critical surgical emergency with high mortality.
- Early diagnosis and intervention are crucial for improving patient outcomes.
Purpose of the Study:
- To analyze recent trends in the management and outcomes of acute mesenteric ischemia.
- To identify predictors of mortality and long-term parenteral nutrition dependence in AMI patients.
Main Methods:
- A retrospective review of 76 patients treated for AMI between 1990 and 2000.
- Analysis of patient demographics, clinical presentation, etiology, management strategies, and outcomes.
- Statistical analysis to determine independent predictors of mortality.
Main Results:
- 63% of patients presented more than 24 hours after symptom onset.
- Intestinal necrosis was present in 81% of cases.
- Perioperative mortality was 62%, with 31% of survivors requiring long-term parenteral nutrition.
- Peritonitis and bowel necrosis at presentation were independent predictors of mortality or TPN dependence.
Conclusions:
- Acute mesenteric ischemia remains a highly lethal condition.
- Delayed presentation and inadequate risk factor recognition contribute to poor outcomes.
- Improved early detection and timely intervention are essential for reducing AMI mortality.