Mesenteric Ischemia – Late Diagnosis or Managed Disease?

Česká verzia

Authors: J. Radoňak; L. Lakyová; T. Toporcer; J. Bober
Authors place of work: L. Pasteura, Košice, Slovenská republika ; I. chirurgická klinika, Lekárska fakulta Univerzity Pavla Jozefa Šafárika, Košice, Fakultná nemocnica
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 4, s. 242-246.
Category: Monothematic special - Original

Summary

Aim:
Diagnosis and therapy of mesenteric ischaemia as the cause of an acute abdomen is a serious problem because of its 60–80% mortality.

The study presents experience with diagnosis and therapy of this disease and it compares its results with those in the literature.

Material and results:
Throughout the years 2000–2009, there were 39 patients surgically treated with mesenteric ischaemia (17 men, 21 women, the average age 73 Ī 9.43). 38.46% of patients underwent resection of small and large bowel, in 33.3% only a part of small intestinum was resected, and in two cases (5.13%), the resection was combined with the embolectomy of artery mesenteric superior. In 23.1% of patients, only an explorative laparatomy was performed, because of an extended affection. Four patients were reoperated (dehiscence of anastomosis, perforation of small bowel, dehiscence of the wound, enterocutaneous fistula). 23% of patients needed ventilation because of postoperative complications such as respiratory insufficiency, sepsis and heart failure. There was 53,8 % mortality. The abdominal pain (79%), vomitus (61.5%) and subileus (35.9%) predominated in the clinical picture. Leucocyts were elevated in 58.97% of patients. X ray examination showed non specific findings, and ultrasonography has proven to be successful in 42.3% of cases.

Conclusion:
Mortality of patients is significantly increased by low success rate of the depictive methods, non-specific clinical picture, co-morbidity in elderly patients and by late arrival to hospital.

Key words:
mesenteric ischemia – ultrasonography – laboratory screening – bowel necrosis – bowel resection – mortality

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