[Mesenteric ischemia in hemodialysis patients]

Area of Science:

• Gastroenterology and Hepatology
• Nephrology
• Vascular Surgery

Context:

• Mesenteric ischaemia (MI) is a critical condition with high mortality, particularly in patients undergoing dialysis.
• Dialysis patients present unique challenges, often experiencing non-occlusive mesenteric attacks.
• Early recognition and intervention are crucial for improving outcomes in this vulnerable population.

Purpose:

• To investigate the clinical characteristics, risk factors, and outcomes of mesenteric ischaemia in patients on hemodialysis.
• To highlight the diagnostic difficulties and the importance of interdisciplinary collaboration.
• To identify factors influencing survival, emphasizing the critical role of timely surgical intervention.

Summary:

• This study analyzed 11 hemodialysis patients diagnosed with mesenteric ischaemia via laparotomy.
• Common findings included cardiovascular disease, hypotension during dialysis, and abdominal pain.
• Necrosis was prevalent (91%), with the ileum frequently affected. Intestinal resection was the primary treatment, with survival strongly correlated with surgery within 8 hours of presentation.

Impact:

• Mesenteric ischaemia should be strongly suspected in dialysis patients presenting with abdominal pain, especially after hypotensive episodes during dialysis.
• Prompt diagnosis and urgent surgical management are essential to reduce the significant morbidity and mortality associated with this condition.
• Findings underscore the need for heightened clinical awareness and rapid surgical response in hemodialysis patients with suspected mesenteric ischaemia.