Acute mesenteric ischemia: An interventional study

Abstract

From 1995 to 2005, 50 patients with mesenteric ischemia diagnosed at laparotomy were studied in Baghdad teaching hospital. Mode of presentation, age, sex, predisposing conditions, diagnostic modalities, operative findings and type of operative procedure performed were all studied and analyzed. There were (24) males and (26) females. Male: female ratio about 0.9: 1, the commonest age groups presented were first between 25 – 35 years (14 patients) and second between 46 – 55 years (16 patients). The main presentation which is abdominal pain and gastrointestinal bleeding (33 cases) was the most lethal one, with a mortality rate of (64.5%). The main physical finding was patient with signs of peritoneal irritation (38 patients) which carries lower mortality rate (21%), while the highest mortality rate was seen in those having combined features of peritoneal irritation and hemodynamic instability (87.5%). The time interval between hospital admission and time of surgery ranged from (< 24 – 244 hours) with a mean =22 patients have two or more predisposing conditions like hypertension, diabetes, ischemic heart disease and atrial fibrillation. Different types of diagnostic modalities were performed, CT scan carries high diagnostic accuracy rate (100 %). The commonest operative findings were focal segmental ischemia (38 cases) explaining the most frequent operative procedure performed which is resection with end to end anastomosis (32 cases). The only significant risk factors affecting the outcome of patients in our study were age (old age group), delayed interval between hospital admission and onset of surgery, late presentation (gastrointestinal bleeding), physical findings (combination of signs of peritoneal irritation and hemodynamic instability), number of predisposing conditions (more than two), operative finding (extensive bowel ischemia) and operative procedure performed (resection with end to end anastomosis).