Challenges Encountered during the Treatment of Acute Mesenteric Ischemia

Abstract

Introduction. Acute mesenteric ischemia, although rare, is associated with numerous complications and death. This work presents acute mesenteric ischemia treatment based on an analysis of various management strategies and identifies prognostic factors that influence therapy effectiveness. Material and Methods. We conducted a retrospective analysis of all patients who were diagnosed with acute mesenteric ischemia due to occlusion and hospitalized between January 1, 2002, and December 31, 2018. Results. Acute ischemia of the bowel mesentery was diagnosed in 41 patients (27 women and 14 men; mean age, 65.4 years). All patients underwent laparotomy. For 13 (31.71%) patients, surgery was performed within the first 24 hours of the clinical symptom onset. Mesenteric artery embolectomy without intestine resection was performed for 7 (17.07%) patients. Partial intestine resection due to necrosis was performed for 21 (51.22%) patients. Exploratory laparotomy without a therapeutic procedure was performed for 13 (31.71%) patients. Fifteen (36.59%) patients were discharged home in good general condition. Twenty-six (63.41%) patients died. The time from the clinical symptom onset until intervention exceeded 24 hours for all patients who died. Surgery within the first 24 hours reduced mortality associated with acute mesenteric ischemia (P=0.001). Female sex, age older than 65 years, obesity (body mass index>30), diabetes, chronic kidney disease, and smoking were adverse prognostic factors for increased mortality for patients with acute bowel ischemia. Conclusion. The time from clinical symptoms to acute mesenteric ischemia treatment was the main prognostic factor and helped determine appropriate management. Early diagnosis and rapid intervention improved treatment outcomes and survival.