Mesenteric ischemia: Results of surgical treatment and a review of literature
Keywords: Mesenteric ischemia, second look, colectomy
AbstractBackground: Acute Mesenteric Ischemia (AMI) is one of the causes of acute abdomen which occurs because of significant decrement in bowel perfusion. Mortality rates of 60 to 100 percent have been reported in different studies in relation to this fatal disease(1, 5, ,11, 16,18,28). In this study, we review clinical features, laboratory findings, abdominal x rays, ECGs, intraoperative findings and results of treatment in 32 patients who were admitted in Shohada-E-Tajrish hospital with final diagnosis of AMI from March 1996 to March 2002.
Methods: 32 patients with final diagnosis of AMI who were admitted in Shohada-E-Tajrish hospital were included in this retrospective study by means of review of their files and medical records.
Results: The disease was more common in men than women, with a 2:1 male: female ratio. The mean age of patients was 60 years. Abdominal pain was the most common symptom of patients followed by nausea, vomiting, obstipation, hematemesis, and melena. On physical exam tachycardia was prevalent. Oliguria was seen in approximately 70% of patients and it was related to mortality. 10% of patients were in shock status related to mortality. 30% of patients had peritoneal signs, but it was not related to mortality. In laboratory tests, leukocytosis was present in 95% of patients, and in 50% of cases it was more than 20000/mm³. Acidosis was seen in 80% of patients and overall mortality rate was 75%.
Conclusion: The final advice of the study is to pay intensive attention to resuscitation of the patients, correction of metabolic and homodynamic derangements, and performing laparotomy as soon as these derangements were corrected. In some patients it is necessary to perform second look operation to evaluation of the viability of the intestine.
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