The role of bed-side laparoscopy in the management of acute mesenteric ischemia of recent onset in post-cardiac surgery
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ORIGINAL ARTICLE
The role of bed‑side laparoscopy in the management of acute mesenteric ischemia of recent onset in post‑cardiac surgery patients admitted to ICU Carlo Bergamini1 · Giovanni Alemanno1 · Alessio Giordano1 · Desiré Pantalone2 · Giovanni Fontani2 · Anna Maria Di Bella2 · Veronica Iacopini2 · Paolo Prosperi1 · Jacopo Martellucci1 Received: 2 April 2020 / Accepted: 8 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Acute mesenteric ischemia with non-occlusive mechanism (NOMI) is a possible complication after cardiac surgery in patients admitted to Intensive Care Unit (ICU). Since the diagnosis is often difficult with CT-scan, some authors have evaluated the role of bed-side diagnostic laparoscopy (DL). We aimed to contribute to this topic with a personal series. Methods We retrospectively evaluated patients admitted to ICU after cardiac surgery since 2009 up to 2019, successively operated on for a suspected NOMI of recent onset with non-conclusive CT. They were divided into laparoscopic (Ls) and laparotomic (Lt) group, depending on whether or not they had a DL. They were compared for the CT false-positive (FP) and true-positive (TP) rate and the surgical outcome. Results Seventy-three patients were enrolled. Lt included 30 patients (41%), Ls 43 (59%). The overall FP were 38 (52%), with a higher incidence in Ls. There was no difference in the mortality rate. The morbidity rate was higher in Lt, and especially in Lt-FP. The TP were 35 (47.9%). The mean operating time (OT) in the Lt-TP group was similar to the sum of the mean OT of the laparotomies plus that of the laparoscopies in the Ls-TP group. Conversely, when considering only laparotomic procedures, the Lt-TP had higher mean OT, such as an increased blood loss Conclusions Post-cardiosurgical patients admitted to ICU have a relatively high rate of NOMI, in which CT-scan is often initially non-conclusive. Our data and those from the literature seem to show that in such cases bed-side DL may be an advantageous and safe procedure to avoid needless laparotomy and enables a more tailored open surgery. Keywords Bed-side laparoscopy · Acute mesenteric ischemia · Intensive care unit · NOMI
Introduction Acute mesenteric ischemia (AMI) is a rare life-threatening disease of the small bowel with an estimated mortality rate of 60–90% [1, 2]. It may arise from an acute obstruction of either the superior mesenteric artery or vein, or from a non-occlusive mechanism (NOMI) due to hemodynamic instability [3, 4].
* Carlo Bergamini [email protected] 1
Department of Emergency Surgery, University Hospital of Careggi, Largo Brambilla n° 3, 50134 Florence, Italy
Medical School, Department of Surgery, University of Florence, Largo Brambilla n° 3, 50134 Florence, Italy
2
AMI may frequently occur as a severe complication after major cardiac surgery, being diagnosed in about 1% of these cases. When post-cardiac surgery patients require a prolonged admission to an Intensive Care Unit (ICU), the risk of AMI w
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