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Summary
Acute mesenteric ischemia has a high mortality rate (65%), with outcomes heavily dependent on the cause. Early diagnosis and appropriate treatment, guided by the specific etiology, are crucial for improving patient survival in mesenteric ischemia.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Emergency Medicine
Background:
- Acute mesenteric ischemia (AMI) is a critical surgical emergency with high mortality.
- Prognosis and treatment strategies for AMI vary significantly based on its underlying cause.
Purpose of the Study:
- To analyze the outcomes of 49 patients treated for AMI over 15 years.
- To correlate diagnostic criteria, therapeutic interventions, and prognostic factors with the specific etiology of AMI.
Main Methods:
- Retrospective review of 49 patients with AMI.
- Analysis of mortality rates, presenting symptoms (peritoneal signs), serum enzyme levels (SGOT, LDH, CPK), and diagnostic procedures (angiography).
- Evaluation of the effectiveness of reexploration and resectional therapy.
Main Results:
- Overall mortality rate was 65%, with survival significantly influenced by etiology (e.g., 0% for arterial thrombosis, 100% for arterial vasculitis).
- Elevated serum enzymes indicated nonocclusive ischemia or thrombosis, while normal levels suggested arterial embolization.
- Angiography proved diagnostic for suspected embolization and nonocclusive ischemia; reexploration had a low survival benefit (17.7%).
Conclusions:
- The etiology of acute mesenteric ischemia is a critical determinant of patient prognosis.
- Diagnostic accuracy can be improved with increased use of angiography, particularly for suspected embolization.
- While reexploration offers limited survival benefit, specific cases of venous thrombosis or arterial embolization may benefit from resectional therapy.