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[Acute obstruction of the mesenteric vessels--a diagnostic and therapeutic problem]
Insights
Acute mesenteric vessel obstruction is more common in males and winter. Early diagnosis and reconstructive surgery are crucial for survival, though overall mortality remains high.
Area of Science:
- Vascular surgery
- Gastroenterology
- Emergency medicine
Context:
- Acute mesenteric vessel obstruction affects 175 patients, with higher incidence in males (2.5:1 ratio) and during winter (62%).
- Thrombus formation and thromboembolism are primary causes, necessitating early diagnostic tools.
- Obstruction predominantly occurs in the superior mesenteric artery stem (57% of cases).
Purpose:
- To analyze the clinical presentation and outcomes of acute mesenteric vessel obstruction.
- To develop a diagnostic table for early detection, reducing reliance on angiography.
- To evaluate the efficacy of surgical interventions and overall patient survival rates.
Summary:
- A diagnostic table was created based on common causes and symptoms, aiding rapid decision-making.
- Reconstructive vascular surgery, with or without intestinal resection, is recommended for permanent cure when feasible.
- Operated patients had an 83.9% mortality rate, while all unoperated patients died, resulting in an overall survival rate of 7.4%.
Impact:
- Highlights the critical need for prompt diagnosis and intervention in acute mesenteric ischemia.
- Underscores the challenges in treating mesenteric vascular emergencies, emphasizing high mortality.
- Informs surgical strategies and the importance of vascular reconstruction for improved outcomes.
Abstract:
Analysis was made of 175 patients treated for acute obstruction of the mesenteric vessels. The incidence was higher in males (male/female ratio = 2.5/l) and in winter--62 per cent of the cases. An the basis of thorough analysis of the most common diseases responsible for thrombus formation and thromboembolism and the basic symptoms in the clinical picture, ad ot table was elaborated for early diagnosis of acute obstruction of mesenterial vessels, enabling to take quick decision even without angiography. The level of obstruction in 57 per cent of the patients was in the stem of the mesenterial arteries; conclusion is hence made that, when possible, only reconstructive vascular operation associated or not with intestinal resection, will lead to permanent cure. Of all 175 patients in this series, 81 (46.5 per cent) were operated and 68 of them (83.9 per cent) died; only 13 survived (16 per cent). All of the unoperated 94 patients (53.5 per cent) died. Hence, a total of 162 patients died (92.6 per cent) and 13 survived (7.4 per cent).