Outcomes of Management of Patients with Acute Mesenteric Ischemia: A Prospective Study

Abstract

Introduction: Acute mesenteric ischemia (AMI) is the sudden onset of small intestinal hypoperfusion, which can be due to reduction or cessation of arterial inflow. It can be embolic or thrombotic. AMI is a potentially fatal vascular emergency, with overall mortality of 60%-80%. The present study was designed to study presentation, risk factors, and various outcomes of AMI patients, who were treated in the tertiary hospital.

Methodology: All patients with features suggestive of AMI were taken in study. All patients underwent explorative laparotomy with exteriorization of bowel after initial resuscitation. Postoperatively, refeeding enteroclysis was done.

Observation and results: The total mortality rate was 62.50%. In patients with functional bowel length of 1 foot, 90.90% patients died. In patients with functional bowel length of 5-6 feet, only 12.50% died. It was observed that the mortality rate was more in the age group of 50-59 years with functional bowel length of 1 foot or <1 foot. Refeeding enteroclysis is an effective technique to use distal bowel. Contrast-enhanced computed tomography of the abdomen more suggestive of this pathology.

Conclusions: A strong clinical suspicion and an aggressive approach should be considered in dealing with this condition because the outcome mainly depends on rapid diagnosis and treatment. With understanding of the pathogenesis of AMI and the better utilization of available radiological investigations, an improved outcome can be achieved. Mortality rates with refeeding enteroclysis are comparable with that of bowel anastomosis. This condition needs future research.

Keywords: Acute mesenteric ischemia; contrast-enhanced computed tomography abdomen; exploratory diagnosis; gangrenous bowel.

Figure 1

Photograph 1 showing ischemic and gangrenous bowel

Figure 2

Photograph 2 showing gangrenous bowel

Figure 3

Photograph 3 showing gangrenous bowel