Factors affecting prognosis in acute intestinal ischemia.
The anamnestic, clinical, laboratory, radiological and intraoperative data on 34 consecutive patients affected by acute intestinal ischemia or infarction, caused by superior mesenteric obstructive and nonocclusive pathology were collected and assessed. The aim of this study is the identification of the factors influencing the prognosis which in this disease is still really displeasing, with a mortality of over 90% in many surveys, and 73.5% in this report. The mean age of the 34 patients was 73. Cardiac ischemic disease and or arrhythmias were present in 83.8% of the patients. The most significant prognostic factors were those related to the evolutive stages of the intestinal ischemia. Among the anamnestic ones, the interval between the onset of the symptoms and diagnosis (mortality of 50% if less than or equal to 24 hrs., 86.4% if greater than 24 hrs.). Among the clinical factors, the presence of peritoneal signs was followed by a mortality of 82.3%, in contrast with the 33.3% when the same signs were absent. Also significant was the presence of shock (100% mortality), in contrast with 50% in patients presenting systemic systolic pressure greater than 100 mmHg. Extensive intestinal infarction caused a 100% mortality rate, while early revascularization allowed the survival of 81.8% of the patients treated in the absence of infarction or when irreversible ischemic damage was limited to less than 1 meter of bowel.
Giulini
S
S
Department of Surgery, University of Brescia, Italy.
Bonardelli
S
S
Cangiotti
L
L
Floriani
M
M
Cervi
G C
GC
Portolani
N
N
Tiberio
G
G
D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000401:mortality*; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000401:mortality*; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013152:Splanchnic Circulation