Prognostic factors in patients with acute mesenteric ischemia

Özet

Objective: Acute mesenteric ischemia, one of the causes of acute abdominal pain due to occlusion of the superiormesenteric artery, has a fatal course as a result of intestinal necrosis. There is no specific laboratory test to diagnoseacute mesenteric ischemia. The basis of treatment in cases of acute mesenteric ischemia is composed of early diagnosis, resection of intestinal sections with infarction, regulation of intestinal blood flow, second look laparotomywhen required, and intensive care support. The aim of this study is to investigate the factors affecting mortality inpatients treated and followed-up with a diagnosis of acute mesenteric ischemia.Material and Methods: Forty-six patients treated and followed-up with a diagnosis of acute mesenteric ischemiabetween January 1st, 2008 and December 31st, 2014 at the General Surgery Clinic of our hospitalwere retrospectivelyevaluated. The patients were grouped as survivor (Group 1) and dead (Group 2). Age, gender, accompanying disorders, clinical, laboratory and radiologic findings, duration until laparotomy, evaluation according to the MannheimPeritonitis Index postoperative complications, surgical treatment applied, and type of ischemia and outcome following surgery were recorded.Results: A total of 46 patients composed of 22 males and 24 females with a mean age of 67.5±17.9 and with adiagnosis of mesenteric ischemia were included in the study. Twenty-seven patients died (58.7%) while 19 survived (41.3%). The mean MPI score was 16.8±4.7 and 25.0±6 in Group 1 and Group 2, respectively, and the difference between the two groups was statistically significant (p<0,001). Fourteen of the 16 (51.9%) patients who had aMannheim Peritonitis Index score of 26 or higher died while two of them survived (10.5%). Thirteen out of the 30(48.1%) patients with a Mannheim Peritonitis Index score of 25 or lower died while 17 (89.5%) patients survived. Theincreased MPI score was significantly correlated withmortality (p=0.004).Conclusion: Suspicion of disease and early use of imaging in addition to clinical and laboratory evaluations areessential in order to decrease mortality rates in acute mesenteric ischemia. Prevention of complications with critical intensive care during the postoperative period aids in decreasingthe mortality rate. In addition, using theMannheim Peritonitis Index can be helpful.