Prognostic factors in patients with acute mesenteric ischemia
Doğan Yıldırım1, Adnan Hut1, Cihad Tatar2, Turgut Dönmez3, Muzaffer Akıncı1, Mehmet Toptaş4
1Clinic of General Surgery, Haseki Training and Research Hospital, İstanbul, Turkey
2Clinic of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
3Clinic of General Surgery, Lütfiye Nuri Burat State Hospital, İstanbul, Turkey
4Clinic of Anesthesiology and Reanimation, Haseki Training and Research Hospital, İstanbul, Turkey
Keywords: Mesenteric ischemia, prognostic factors, mannheim
Objective: Acute mesenteric ischemia (AMI), one of the causes of acute abdominal pain due to the occlusion of superior mesenteric artery, has a fatal course as a result of intestinal necrosis. There is no specific laboratory test for acute mesenteric ischemia. The basis of treatment in cases of acute mesenteric ischemia is composed of early diagnosis, resection of the intestinal sections with infarct development, the regulation of intestinal blood flow, second look laparotomy when required, and intensive care support. The aim of this study is to investigate the factors affecting mortality in patients treated and followed-up with a diagnosis of AMI.
Material and Methods: Forty-six patients treated and followed-up with a diagnosis of AMI between January 1st, 2008 and December 31st, 2014 at the general surgery clinic of our hospital, were retrospectively evaluated. The patients were grouped as survivors (Group 1) and dead (Group 2). Age, gender, accompanying disorders, clinical, laboratory and radiological findings, duration until laparotomy, evaluation according to the Mannheim Peritonitis Index (MPI), postoperative complications, and 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 a diagnosis 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 died had a MPI score of 26 or higher, while two of them survived (10.5%). Thirteen of the patients among the 30 (48,1%) who died had a MPI score of 25 or lower, while 17 (89.5%) patients survived. The increased MPI score was found to be statistically significantly effective on mortality (p=0.004).
Conclusion: Primarily, in order to decrease mortality in AMI, suspicion of the disease and the early use of imaging (CT angiography) in addition to clinical and laboratory evaluation, is important. The prevention of complications with critical intensive care during the postoperative period helps to decrease mortality. Also, using the Mannheim Peritonitis Index can be helpful.
Cite this paper as: Yıldırım D, Hut A, Tatar C, Dönmez T, Akıncı M, Toptaş M. Prognostic factors in patients with acute mesenteric ischemia. Turk J Surg 2017; 33(2): 104-109
Ethics committee approval was received for this study from the ethics committee of Haseki Training and Research Hospital.
Written informed consent was obtained from patient who participated in this study.
Concept - D.Y., C.T., A.H.; Design - D.Y., C.T., A.H.; Supervision - T.D., M.A., M.T.; Resource - D.Y., C.T., A.H; Materials - T.D., M.A., M.T.; Data Collection and/or Processing - D.Y., A.H., C.T., T.D., M.T.; Analysis and/or Interpretation - D.Y., A.H., C.T., T.D.; Literature Search - C.T., T.D.; Writing Manuscript -D.Y., C.T., T.D.; Critical Reviews - D.Y., C.T., T.D., M.A.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.