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Acute Mesenteric Ischaemia-An Indian Perspective.

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In India, acute mesenteric ischemia is often caused by venous thrombosis, affecting younger patients compared to Western countries. Arterial causes and low albumin/high creatinine predict higher mortality.

Keywords:
GangreneIschaemiaMesentericThrombosis

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Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Internal Medicine

Background:

  • Acute mesenteric ischemia (AMI) is a surgical emergency with high mortality.
  • In Western countries, arterial occlusion is the primary cause of AMI, typically in older patients.
  • Venous causes of AMI are less common in the West, accounting for only 10% of cases.

Purpose of the Study:

  • To investigate the causes and clinical features of AMI in India.
  • To compare the outcomes of arterial versus venous mesenteric ischemia.
  • To identify predictors of mortality in Indian patients with AMI.

Main Methods:

  • Retrospective analysis of 117 patients diagnosed with AMI between January 1997 and October 2012.
  • Data collected included demographics, presentation, imaging, blood tests, extent of bowel ischemia, resection length, and outcome.
  • Multivariate analysis was used to identify mortality predictors.

Main Results:

  • Mesenteric venous thrombosis (48%) and arterial occlusion (52%) were equally common in India.
  • Patients with venous ischemia were younger (median age 53 vs. Western decades), presented with longer symptom duration, and had lower mortality (27% vs. 51%).
  • Mortality predictors included arterial cause, longer symptom duration, low serum albumin, high creatinine, and shorter residual bowel length.

Conclusions:

  • In India, AMI is caused by venous thrombosis in nearly half of cases, with patients being a decade younger than in the West.
  • Venous mesenteric ischemia is associated with a better prognosis than arterial occlusion.
  • Low serum albumin, high creatinine, and shorter residual bowel length are significant predictors of mortality in AMI.