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 18 November 2017

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News

Surgical management of acute occlusive mesenteric ischemia

Acute mesenteric ischemia remains a lethal condition due to advanced presentation and inadequate recognition, finds a research team in the January issue of the Annals of Vascular Surgery.

News image

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Acute mesenteric ischemia secondary to arterial occlusion (AMI) remains a highly lethal condition.

In this study, researchers from the United States examined recent trends in management and associated outcomes.

They reviewed their institutional experience over a 10-year period.

The research team identified all patients treated for AMI between 1990 and 2000.

Perioperative mortality was 62%.
Annals of Vascular Surgery

They included 76 patients (77 cases), and examined their medical records.

The researchers found that at presentation 64% demonstrated peritonitis and 30% hypotension.

The interval from symptom onset to treatment exceeded 24 hours in 63% of cases.

The team found that etiology was mesenteric thrombosis in 58% of patients and embolism in 42%.

Overall, 46% had prior conditions placing them at high risk for the development of AMI, including chronic mesenteric ischemia (n = 26) and inadequately anticoagulated chronic atrial fibrillation (n = 9).

The researchers determined that surgical management consisted of exploration in 16 patients, bowel resection in 18, and revascularization in 43 patients. The latter included 28 who required concomitant bowel resection.

The team discovered that intestinal necrosis was present in 81% of cases.

Perioperative mortality was 62%, while long-term parenteral nutrition (TPN) was required in 31% of survivors.

Peritonitis (odds ratio 9.4) and bowel necrosis (10.4) at presentation were independent predictors of death or survival dependent upon TPN.

Dr Matthew Edwards’s team concluded, “AMI remains a highly lethal condition due in large part to advanced presentation and inadequate recognition and treatment of patients at high risk”.

Ann Vasc Surg 2003; 16(1): 72-9
26 February 2003

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