SINGLE CENTER EXPERIENCE IN MANAGEMENT OF ACUTE MESENTERIC ISCHEMIA AND THE IMMEDIATE OUTCOME FOLLOWING SURGICAL SALVAGE

Acute Mesenteric Ischemia is a rare condition with an incidence of 5/100,000. Occlusive subtype has the better outcome if early presentation and urgent surgical intervention is made. The study was conducted at Lahore General Hospital, Lahore from Jan, 2016 to Jan, 2018. During this time period 12 patients were enrolled in the study fulfilling the inclusion and exclusion criteria. Mean age was 58 years and all were male (range 45 - 75 years). All 12 patients were symptomatic at presentation with severe abdominal pain (94.3%), abdominal distension (63.6%) and vomiting (40.4%) alone or in combination. 7 patients (58.3%) presented within 24 hours from the onset of symptoms whereas 5 patients (41.6%) presented late. All patients who presented within 24 hours of onset of symptoms survived whereas all patients who presented after 24 hours from the onset of symptoms could not survive. The mortality rate for early presenters was zero % while for late presenters it was 100 %. On whole the mortality rate for our 12 patients with Acute Mesenteric Ischemia was 41.7 %. Conclusion Acute mesenteric ischemia patient presentation within 24 hours from the onset of symptoms with early diagnosis and surgical intervention had much better outcome.

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Acute mesenteric ischemia: analysis of cases admitted to a hospital during 10 years (2001–2010)

Orvosi Hetilap ◽

10.1556/oh.2012.29444 ◽

2012 ◽

Vol 153 (36) ◽

pp. 1424-1432 ◽

Cited By ~ 3

Author(s):

Erzsébet Szabóné Révész

Keyword(s):

Survival Rate ◽

Mortality Rate ◽

Early Diagnosis ◽

Mesenteric Ischemia ◽

Surgical Intervention ◽

Acute Mesenteric Ischemia ◽

Intestinal Necrosis ◽

Acute Surgery ◽

The Poor ◽

Study Results

Acute mesenteric ischemia is a rare disorder; it occurs in an average of 0.4% of acute surgery cases. Its diagnosis is often difficult because of the poor symptoms, and mortality of the patients is still as high as 70–90%. Aims: The aims of the study were to assess the importance of time factor that may influence the outcome of the disease and to find out whether it is possible to decrease the high mortality of patients. Method: Among patients admitted to Szent Pantaleon Hospital in Hungary between January 2001 and December 2010, patients whose surgery or autopsy findings confirmed intestinal necrosis were analyzed. A total of 114 patients with acute mesenteric ischemia were included in the study. Results: 55% of the patients had typical symptoms. 43.8% of the patients underwent surgery and among these patients the mortality rate was 70% despite surgical intervention. The survival rate was 72.3% when surgery was performed within less than 12 hours after the onset of symptoms, but only 20% of patients survived when surgery was delayed between 24 and 48 hours after the onset of symptoms. Conclusion: With early diagnosis and intervention, patients with acute mesenteric ischemia may have a better a chance to survive. Orv. Hetil., 2012, 153, 1424–1432.

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Acute Mesenteric Ischemia: The Importance of Early Surgical Consultation

The American Surgeon ◽

10.1177/000313480907500305 ◽

2009 ◽

Vol 75 (3) ◽

pp. 212-219 ◽

Cited By ~ 13

Author(s):

Islam G. Eltarawy ◽

Yasser M. Etman ◽

Mazen Zenati ◽

Richard L. Simmons ◽

Matthew R. Rosengart

Keyword(s):

Odds Ratio ◽

Retrospective Cohort ◽

Mesenteric Ischemia ◽

Disease Onset ◽

Lactate Concentration ◽

Acute Mesenteric Ischemia ◽

Abdominal Distension ◽

Ct Imaging ◽

Appropriate Care ◽

Elevated Lactate

Acute mesenteric ischemia continues to be associated with high mortality. We hypothesized that delays in surgical consultation and operation are independently associated with increased mortality and sought to identify modifiable characteristics associated with delayed management. We conducted a retrospective cohort study of 72 patients diagnosed with acute mesenteric ischemia. Twenty-six (36%) patients died, of which 14 (54%) had care withdrawn. Delay in operation (>6 hours after surgical consultation) was associated with increased mortality (adjusted OR 3.7; 90% CI, 1.1-12). For patients for whom care was not withdrawn, delay in surgical consultation (>24 hours after disease onset) was associated with increased mortality (adjusted OR, 9.4; 90% CI, 1.3-65), as was delay in operation (adjusted OR, 4.9; 90% CI, 1.1-22). For those managed medically, early surgical consultation was associated with improved mortality (Odds Ratio [OR], 0; 90% Confidence Interval [CI], 0-0.34). Patients with delayed surgical consultation were more likely to have abdominal distension, elevated lactate concentration, acute renal failure, vasopressor administration, and a lack of abdominal pain. The acquisition of CT imaging trended toward an association with delayed surgical consultation ( P = 0.06). We conclude that early surgical consultation is associated with improved outcome even for patients managed without operative intervention, and that CT imaging may delay appropriate care.

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Problems of the Diagnosis and Treatment of Acute Mesenteric Ischemia: a SingleCenter Experience

Journal of Anesthesia & Pain Medicine ◽

10.33140/japm/03/04/00004 ◽

2018 ◽

Vol 3 (4) ◽

Keyword(s):

Blood Flow ◽

Mortality Rate ◽

Early Diagnosis ◽

High Mortality ◽

Mesenteric Ischemia ◽

Intestinal Resection ◽

Acute Mesenteric Ischemia ◽

Mesenteric Arteries ◽

Diagnosis And Treatment ◽

Number Of Patients

Objective: To improve the diagnosis and treatment of acute mesenteric ischemia by using available methods of early diagnosis and modern methods of treatment. Summary Background Data: The number of patients with disorders of the mesenteric circulation is increasing all over the world. In comparison with the occlusion of the coronary, cerebral arteries and peripheral veins, acute obstruction of the mesenteric arteries and veins is diagnosed much later, which causes a high mortality rate from 53 to 100%. Methods: In this study the experience of treatment of 162 patients with acute mesenteric ischemia was analyzed. All patients underwent treatment in Institute of Urgent and Recovery Surgery (IURS NAMS, Donetsk, Ukraine) from 2002 to 2017. Results: From 162 patients: 112 patients were with acute occlusive and 50 patients with acute nonocclusive mesenteric ischemia. The intravital diagnosis was not confirmed in 26 patients (16 %). 119 of patients died, the level of mortality was 73, 5%. 104 patients were operated, 32 patients were discharged (30,8 %), 72 patients died, a mortality rate was 69,2 %. Operations with restore of blood flow were performed in 14 patients, 5 patients died, 9 patients left the hospital. Conservative therapy was performed in 22 patients, in 11 patients with good results (50 %). Conclusions: The early diagnosis of this pathology is crucial and it can reduce the high mortality rate of patients with AMI. Treatment of OAMI should be carried out in a community of general, vascular and endovascular surgeons. Restoration of blood flow through mesenteric vessels with the help of endovascular technology and implementation of thrombembolectomy during open surgical intervention in a number of cases allows to avoid intestinal resection.

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Outcome of African-American (AA) Multiple Myeloma (MM) Patients after Autologous Stem Cell Transplantation (ASCT): A Single-Center Experience.

Blood ◽

10.1182/blood.v112.11.3327.3327 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3327-3327

Author(s):

Yin Wu ◽

Olga Goloubeva ◽

Kathleen Ruehle ◽

Saul Yanovich ◽

Aaron P. Rapoport ◽

...

Keyword(s):

Mortality Rate ◽

Access To Health Care ◽

Cox Regression ◽

The Past ◽

Single Center Experience ◽

Time Period ◽

Younger Age ◽

Access To Health ◽

Significant Difference ◽

Caucasian Patients

Abstract The incidence of MM in African-Americans is more than double that in Caucasians. Historically AAs have had a higher mortality rate than Caucasians; but over the past 10 yrs, the age-adjusted mortality rate has been on the decline for AAs while it has been stable for Caucasians as a result of ASCT and novel agents. Previous studies (n=74 AA patients) suggested that response to ASCT is similar, if not better, for AA patients (Verma et al 2008, Saraf et al 2006). We retrospectively analyzed the clinical presentation of a large cohort of AA patients (n=103) who underwent ASCT at our center between 1998 and 2008 and compared their outcome to that of Caucasians patients (n=183) transplanted in the same time period. AA patients were significantly younger than Caucasian patients at diagnosis with median age 53 (range: 32–75) vs 59 (range: 27–80), respectively (p<0.0001). The distribution of isotype and stage of MM at diagnosis were similar between the two groups. Approximately 20% patients in each group presented with renal insufficiency. Among the AA patients, 45% had albumin < 3.5 g/dL; 14% and 18% had beta2-microglobulin > 3.5 mg/L and > 5.5 mg/L, respectively. Initial cytogenetic data were not available for the majority of patients. Median time from diagnosis to ASCT was significantly longer for AA than for Caucasian patients at 0.8 yrs (range: 0.23–9.2) vs 0.5 yrs (range: 0.1– 7.0), respectively (p<0.0001). There was no difference in incidence of transplant-related complications, as reflected by similar lengths of hospital stay, with a median of 15 days for both groups. No significant difference in response to ASCT was found between the two groups. Median EFS was 1.7 yrs (range: 1.5–2.7) for AAs and 1.8 yrs (range: 1.5–2.4) for Caucasians (p=NS). At a median follow up of 5 yrs, 74% of AA and 70% of Caucasian patients were alive. Median OS was also not significantly different at 9 yrs (range: 6.7- not reached) for AAs and 8 yrs (range: 5.9-not reached) for Caucasians (p=NS). Cox regression model for prognostic markers: albumin, calcium, creatinine, hemoglobin, and platelet count were significant for OS in AA patients (p range 0.004–0.0001). The current study is the largest one of AA patients undergoing SCT at a single institution. AA patients with MM present at a younger age, but undergo ASCT at a significantly later time from diagnosis than Caucasian patients. This delay may reflect a disparity in referral pattern and access to health care. AA patients have similar EFS and OS after ASCT. It is likely that better responses to the newer anti-myeloma agents, as well as favorable impact of ASCT, even if delayed, may explain the improvement of AA patients with MM over the past decade. Further studies of responses of AA patients to novel myeloma agents are needed.

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A rapid preliminary prediction model for intestinal necrosis in acute mesenteric ischemia: a retrospective study

BMC Gastroenterology ◽

10.1186/s12876-021-01746-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xinsuo Zhuang ◽

Fumei Chen ◽

Qian Zhou ◽

Yuanrun Zhu ◽

Xiaofeng Yang

Keyword(s):

Logistic Regression ◽

Retrospective Study ◽

Prediction Model ◽

Mesenteric Ischemia ◽

Surgical Intervention ◽

Univariate Analysis ◽

Acute Mesenteric Ischemia ◽

Intestinal Necrosis ◽

Wbc Count ◽

Early Surgical Intervention

Abstract Background Acute mesenteric ischemia (AMI) is a life-threatening condition. However, there is no accurate method to predict intestinal necrosis in AMI patients that may facilitate early surgical intervention. This study thus aimed to explore a simple and accurate model to predict intestinal necrosis in patients with AMI. Methods A single-center retrospective study was performed on the data of 132 AMI patients treated between October 2011 and June 2020. The patients were divided into the intestinal necrosis and non-intestinal necrosis groups. The clinical characteristics and laboratory data were analyzed by univariate analysis, and the variables with statistical significance were further analyzed by multivariate logistic regression analysis. The independent predictors of intestinal necrosis were determined and a logistic prediction model was established. Finally, the accuracy, sensitivity, and specificity of the model in predicting intestinal necrosis were evaluated. Results Univariate analysis showed that white blood cell (WBC) count, blood urea nitrogen (BUN) level, neutrophil ratio, prothrombin time (PT), and LnD-dimer were associated with intestinal necrosis. According to logistic regression multivariate analysis, WBC count, BUN level and LnD-dimer were independent predictors of intestinal necrosis. These parameters were used to establish a clinical prediction model of intestinal necrosis (CPMIN) as follows: model score = 0.349 × BUN (mmol/L) + 0.109 × WBC × 109 (109/L) + 0.394 × LnD − Dimer (ug/L) − 7.883. The area under the receiver operating characteristics (ROC) curve of the model was 0.889 (95% confidence interval: 0.833–0.944). Model scores greater than − 0.1992 predicted the onset of intestinal necrosis. The accuracy, specificity, and sensitivity of the model were 82.6%, 78.2%, and 88.3%, respectively. The proportion of intestinal necrosis in the high-risk patient group (CPMIN score ≥ − 0.1992) was much greater than that in the low-risk patient group (CPMIN score < − 0.1992; 82.7% vs. 15.0%, p < 0.001). Conclusion The CPMIN can effectively predict intestinal necrosis and guide early surgical intervention to improve patient prognosis. Patients with AMI who are classified as high-risk should be promptly treated with surgery to avoid the potential complications caused by delayed operation. Patients classified as low-risk group can receive non-surgical treatment. This model may help to lower the morbidity and mortality from AMI. However, this model’s accuracy should be validated by larger sample size studies in the future.

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Factors Associated With in-Hospital Death in Patients with Acute Mesenteric Artery Ischemia

Journal Of Cardiovascular Emergencies ◽

10.2478/jce-2018-0019 ◽

2018 ◽

Vol 4 (3) ◽

pp. 133-139

Author(s):

Előd Etele Élthes ◽

Alexandra Lavinia Cozlea ◽

Árpád Török

Keyword(s):

Emergency Department ◽

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Surgical Intervention ◽

Acute Mesenteric Ischemia ◽

Mesenteric Arteries ◽

Hospital Death ◽

Acute Ischemia ◽

Factors Associated ◽

Hospitalization Period

ABSTRACT Objective: The aim of the study was to assess the factors associated with increased mortality in patients with acute mesenteric ischemia, emphasizing the importance of an early diagnosis and a prompt surgical intervention in order to avoid lesion progression. Materials and method: A retrospective analytical study was conducted on a study population of 50 male and female patients with acute ischemia of the mesenteric arteries, aged between 36-92 years. Demographic and pathological history characteristics were assessed, together with presented symptoms, laboratory and CT findings, as well as surgical outcome and time-related aspects between presentation in the emergency department and time of surgery, as well as the hospitalization period until discharge or death. Results: Muscular defense (OR = 23.05) and shock (OR = 13.24) as symptoms were strongly associated with a poor prognosis, while elevated values of lactate dehydrogenase (p = 0.0440) and creatine kinase (p = 0.0025) were associated with higher death rates. The time elapsed during investigations in the emergency room was significantly higher in patients who deceased (p = 0.0023), similarly to the total time from the onset of symptoms to the beginning of surgery (p = 0.0032). Surgical outcomes showed that patients with segmental ischemia of the small bowel had significantly higher chances of survival (p <0.0001). Conclusion: Increased mortality rates in patients presenting in the emergency department for acute mesenteric ischemia were observed in patients with occlusion of the superior mesenteric artery, with higher levels of CK and LDH, as well as with longer periods of stay in the emergency department for diagnostic procedures until the commencement of the surgical intervention. Therefore, proper investigations in a timely manner followed by a specific and prompt surgical intervention may avoid unfavorable evolution of patients towards death.

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A Rapid Prediction Model for Intestinal Necrosis in Acute Mesenteric Ischemia: A Retrospective Study

10.21203/rs.3.rs-152495/v1 ◽

2021 ◽

Author(s):

Xinsuo Zhuang ◽

Fumei Chen ◽

Qian Zhou ◽

Yuanrun Zhu ◽

Xiaofeng Yang

Keyword(s):

Logistic Regression ◽

Retrospective Study ◽

Prediction Model ◽

Mesenteric Ischemia ◽

Surgical Intervention ◽

Univariate Analysis ◽

Acute Mesenteric Ischemia ◽

Intestinal Necrosis ◽

Wbc Count ◽

Early Surgical Intervention

Abstract Background：Acute mesenteric ischemia (AMI) is a life-threatening condition. However, there is no accurate method to predict intestinal necrosis in AMI patients that may facilitate early surgical intervention. This study thus aimed to explore a simple and accurate model to predict intestinal necrosis in patients with AMI.Methods: A single-center retrospective study was performed on the data of 132 AMI patients treated between October 2011 and June 2020. The patients were divided into the intestinal necrosis and non-intestinal necrosis groups. The clinical characteristics and laboratory data were analyzed by univariate analysis, and the variables with statistical significance were further analyzed by multivariate logistic regression analysis. The independent predictors of intestinal necrosis were determined and a logistic prediction model was established. Finally, the accuracy, sensitivity, and specificity of the model in predicting intestinal necrosis were evaluated. Results: Univariate analysis showed that white blood cell (WBC) count, blood urea nitrogen (BUN) level, neutrophil ratio, prothrombin time (PT), and LnD-dimer were associated with intestinal necrosis. According to logistic regression multivariate analysis, WBC count, BUN level and LnD-dimer were independent predictors of intestinal necrosis. These parameters were used to establish a clinical prediction model of intestinal necrosis (CPMIN) as follows: model score = 0.349×BUN (mmol/L) +0.109×WBC×109+0.394×LnD-Dimer-7.883. The area under the receiver operating characteristics (ROC) curve of the model was 0.889 (95% confidence interval: 0.833–0.944). Model scores greater than -0.1992 predicted the onset of intestinal necrosis. The accuracy, specificity, and sensitivity of the model were 82.6%, 78.2%, and 88.3%, respectively. The proportion of intestinal necrosis in the high-risk patient group (CPMIN score ≥ -0.1992) was much greater than that in the low-risk patient group (CPMIN score < -0.1992; 82.7% vs. 15.0%, p<0.001).Conclusion：The CPMIN can effectively predict intestinal necrosis and guide early surgical intervention to improve patient prognosis. Patients with AMI who are classified as high-risk should be promptly treated with surgery to avoid the potential complications caused by delayed operation. Patients classified as low-risk group can receive non-surgical treatment. This model may help to lower the morbidity and mortality from AMI.

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Nonocclusive Mesenteric Ischemia Associated with Ogilvie Syndrome

Case Reports in Surgery ◽

10.1155/2014/821832 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Takashi Sakamoto ◽

Toshiyuki Suganuma ◽

Shinichiro Okada ◽

Kensuke Nakatani ◽

Sawako Tamaki ◽

...

Keyword(s):

Small Bowel ◽

Mesenteric Ischemia ◽

Colonic Obstruction ◽

Acute Mesenteric Ischemia ◽

Pneumatosis Intestinalis ◽

Abdominal Distension ◽

Emergency Laparotomy ◽

Nonocclusive Mesenteric Ischemia ◽

Ischemic Bowel ◽

Ogilvie Syndrome

Nonocclusive mesenteric ischemia (NOMI) is one type of acute mesenteric ischemia. Colonic pseudoobstruction, known as Ogilvie syndrome, is a disorder defined by colonic distension in the absence of mechanical obstruction. A relationship between these diseases has not yet been reported, based on a review of the literature. We report a patient with NOMI secondary to Ogilvie syndrome. An 82-year-old woman reported three days of intermittent abdominal pain. Plain computed tomography scan showed colonic obstruction at the rectosigmoid colon. Colonoscopy was performed that showed a large amount of stool and no evidence of tumor or other physical causes of obstruction. We diagnosed the patient with Ogilvie syndrome and continued nonoperative management. On the third hospital day, she complained of abdominal distension. A repeat CT scan showed pneumatosis intestinalis in the small bowel and ascending colon, with portal venous gas. Emergency laparotomy was performed with diagnosis of mesenteric ischemia. Intraoperatively, there were multiple skip ischemic lesions in the small intestine and cecum. We resected the ischemic bowel and performed a distal jejunostomy. Her residual small bowel measured just 20 cm in length. Postoperatively, her general status gradually improved. She was discharged with total parenteral nutrition and a small amount of enteral nutrition.

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Nutritional Treatment of Patients Operated on for Acute Mesenteric Ischemia

Acta Medica ◽

10.32552/2021.actamedica.536 ◽

2021 ◽

pp. 1-6

Author(s):

Timuçin Erol ◽

Şermin Ataç ◽

Kezban Akçay ◽

Nilgün Ölmez ◽

Nezih Akkapulu ◽

...

Keyword(s):

Mortality Rate ◽

Length Of Stay ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Nutritional Management ◽

Nutritional Treatment ◽

Significant Difference ◽

Overall Mortality

Objective: Acute mesenteric ischemia is a surgical emergency. During the course of treatment, most of the patients require nutritional treatment. However, achieving nutritional goals may not be always possible. This study aimed to investigate nutritional management of the patients who were operated on for acute mesenteric ischemia. Materials and Methods: Patients who were diagnosed and hospitalized for acute mesenteric ischemia between 2015 and 2018 were retrospectively analyzed. Nutritional management of patients was studied in terms of hospital length of stay, mortality rate and achieving of nutritional goals. Results: Thirty patient were included in the study and 18 patient received nutritional treatment. Median length of stay was 28.5 (range:9-220) days. Target nutrition goals were only achieved in 11 patients (61%). Overall mortality rate for nutritional treatment group was 50%. There was no significant difference between the patients whose treatment objectives were achieved or failed in terms of length of stay (p=0.375) or mortality [(p=0.630 (95% CI0,237-10,809)]. Conclusion: The management of nutritional treatment of acute mesenteric ischemia patients is challenging. Achieving the nutritional goals may not be possible in many patients.

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Evaluation of outcome in Mesenteric Ischemia

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.17.05.02.03 ◽

2017 ◽

Vol 5 (2) ◽

pp. 13

Author(s):

Samad Shams Vahdati ◽

Ozgur Tatli ◽

Mohammad Taghizadieh ◽

Roshan Fahimi ◽

Neda Gholamzadeh ◽

...

Keyword(s):

Emergency Department ◽

Mortality Rate ◽

Early Diagnosis ◽

Physical Examination ◽

Mesenteric Ischemia ◽

Clinical Signs ◽

Acute Mesenteric Ischemia ◽

P Value ◽

Threatening Condition ◽

Life Threatening

Background: Acute mesenteric ischemia (AMI) is an infrequent but a complicated life threatening condition. It is the leading causes of mortality with the rate of 60-100%. The purpose of our study is to investigate demographic outcomes of the patients referred to the emergency department of Imam Reza hospital with the diagnosis of AMI. Methods and materials: All patients with the diagnosis of AMI from March 2014 to March 2016 who were referred to emergency department of Imam Reza hospital, were studied. Demographic characteristics (age, sex, the period from symptom onset till laparotomy), risk factors and the last outcomes of patients were noted in the check lists for each patient. P value less than 0.05 was determined as significant. Results: from 111 patients, 76 cases (68.8%) were male, 35 cases (31.5%) were female. Chief complaint of all patients was stomachache. Period of arriving to the emergency room in 5 cases (4.5%) was 1-6 hours, in 3 cases (2.7%) was 6-12 hours, and in 103 cases (92.8%) has taken more than 12 hours. In 55 cases (49.5%), there was a significant relationship between clinical signs and physical examination findings, whereas in 56 cases (50.5%) there was no relation. In our study 42 cases (37.8%) were treated, whereas the morbidity and mortality rate were respectively 7 (6.3%) and 62 (55.9%). According to the results of our study the most important finding was pain which was disproportionate to physical examination findings (P value< 0.052). Conclusion: Acute mesenteric ischemia is a severe and progressive disease so early diagnosis and appropriate treatment are very important. One of the main reasons of higher mortality rate in AMI is difficulty in early diagnosis, before necrosis occurrence. Major factor that determines the survival rate is the accurate diagnosis before necrosis and peritonitis happens.

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