The importance of open emergency surgery in the treatment of acute mesenteric ischemia
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WORLD JOURNAL OF EMERGENCY SURGERY
RESEARCH ARTICLE
Open Access
The importance of open emergency surgery in the treatment of acute mesenteric ischemia Mansur Duran*, E. Pohl, K. Grabitz, H. Schelzig, T. A. Sagban and F. Simon
Abstract Objective: Acute mesenteric ischemia (AMI) is a complex disease with a high mortality rate. A patient’s chance of survival depends on early diagnosis and rapid revascularization to prevent progression of intestinal gangrene. We reviewed our experience with open surgery treatment in 54 cases of AMI. Methods: A monocentric retrospective study was conducted between 01/01/2001 and 04/30/2014; 54 AMI patients with a mean age of 56.6 years underwent surgery (26 women and 28 men). Retrospectively, the risk factors, management until diagnosis, vascular therapy and follow-up were evaluated. Results: The symptom upon admission was an acute abdominal pain event. The delay time from admission to surgery was, on average, 13.9 h (n = 34). The therapeutic procedures were open surgical operations. The complication rate was (53.7 %) (n = 29). The 30-day mortality was 29.6 % (n = 16). The late mortality rate was 24.1 % (n = 13), and the cumulative survival risk was 44.6 %. Survival was, on average, 60.54 months; however, in the over 70-year-old patient subgroup, the survival rate was 9.5 months (p = 0.035). The mortality rate was 27 % (n = 22) in the 24 h delay group. Conclusions: The form of therapy depends on the intraoperative findings and the type of occlusion. Although the mortality rate has decreased in the last decade, in patients over 70 years of age, a significantly worse prognosis was seen. Keywords: Mesenteric ischemia, Mesenteric infarction, Superior mesenteric artery, Vascular reconstruction, Endovascular treatment
Introduction Cardiac arrhythmia with embolism is a frequent cause of acute mesenteric ischemia (AMI). An acute closure of the superior mesenteric artery (SMA) frequently leads to irreversible damage of the intestinal mucosa within 6 h [1]. The status of the celiac and SMA - celiac collaterals as well as the hemodynamic status of the patient can be important for AMI. Patients primarily present with an acute pain event, which is followed by an interval of reduced pain intensity due to the decline of intramural pain receptors arising from the hypoperfusion of the intestinal wall. As a result, this disease is often not initially recognized as a vascular emergency, which leads to the possibility of delays in making the appropriate diagnosis and initiating treatment. Further along the course of the * Correspondence: [email protected] Clinic for Vascular- and Endovascular Surgery, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
disease, intestinal wall gangrene develops due to the destruction of the mucosal barrier, followed by bacterial translocation, which may lead to peritonitis, sepsis and multi-organ failure. Therefore, AMI comes with a high mortality rate (50–70 %) [2]. Prognostic factors include delays in diagnosis and in the revascularizat
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