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Updated: May 19, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Predictors of Survival Following Acute Nontraumatic Mesenteric Ischemia in North India: A Prospective Observational
Vivek K Bhagat1, Ashok K Puranik2, Satya Prakash Meena1
1General Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND.
Introduction:
Acute mesenteric ischemia (AMI) is a life-threatening and rare cause of abdominal pain. No single laboratory test or clinical finding helps diagnose or predict the prognosis of AMI.
Aim:
This study aimed to determine the morbidity and prognostic factors that affect the postoperative outcomes of patients undergoing surgery for bowel ischemia.
Methodology:
This prospective observational study was conducted between July 2019 and December 2020 in North India. The study included 40 patients undergoing surgery for bowel ischemia. Patients under 18 years of age and those with bowel ischemia following trauma were excluded.
Results:
A total of 40 patients were treated, out of whom 15 (37.5%) survived. Overall mortality was 62.5% (25/40). The mean age of the study population was 56.18 years. Compared with survivors, arterial pH was significantly lower (7.36 vs. 7.40, P = 0.031), C-reactive protein (CRP) levels were higher (194.30 mg/L vs. 128.70 mg/L, P = 0.017), and lactate dehydrogenase (LDH) levels were also elevated in deceased patients (471.22 U/L vs. 335.80 U/L, P = 0.016). Distal to the duodenojejunal (DJ) junction, the remaining small bowel length was significantly shorter in deceased patients than in survivors (45 cm vs. 142 cm, P < 0.001). All six patients (15%) who had large bowel involvement died. Postoperative complications included relaparotomy in 15 patients (37.5%), anastomotic leak in 6 patients (15%), and requirement of ventilatory support in 16 patients (40%).
Conclusions:
AMI continues to carry a high risk of mortality, particularly in patients presenting late with extensive bowel involvement and systemic complications. The use of antiplatelet drugs is an effective way to prevent severe complications. Patient age, pH, LDH, CRP, serum lactate, remaining length of small bowel from DJ, and large bowel involvement are significant predictors of mortality.
Insights
Acute mesenteric ischemia (AMI) has a high mortality rate. Key predictors of death include patient age, low pH, elevated lactate dehydrogenase (LDH) and C-reactive protein (CRP), and extensive bowel involvement.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Critical Care Medicine
Background:
- Acute mesenteric ischemia (AMI) is a critical condition with high mortality and no definitive diagnostic markers.
- Early diagnosis and prognostic assessment are crucial for improving patient outcomes.
Purpose of the Study:
- To identify morbidity and prognostic factors influencing postoperative outcomes in patients with bowel ischemia requiring surgery.
- To analyze predictors of mortality in patients undergoing surgery for AMI.
Main Methods:
- A prospective observational study conducted in North India from July 2019 to December 2020.
- Included 40 adult patients undergoing surgery for bowel ischemia, excluding trauma cases.
- Collected data on patient demographics, clinical findings, laboratory values, and postoperative outcomes.
Main Results:
- Overall mortality was 62.5% (25/40). Survivors had higher arterial pH, lower C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels compared to non-survivors.
- Deceased patients had significantly shorter remaining small bowel length distal to the duodenojejunal (DJ) junction (45 cm vs. 142 cm).
- Large bowel involvement (15% of patients) resulted in 100% mortality. Common complications included relaparotomy (37.5%) and anastomotic leak (15%).
Conclusions:
- AMI remains a high-risk condition, especially with late presentation, extensive bowel compromise, and systemic complications.
- Predictors of mortality include patient age, arterial pH, LDH, CRP, serum lactate, remaining small bowel length, and large bowel involvement.
- Antiplatelet drugs may help prevent severe complications.
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