Surgical intervention for acute intestinal ischemia: experience in a community teaching hospital.
The aim of this study was to evaluate the current management of acute mesenteric ischemia secondary to thrombotic or embolic occlusion of visceral vessels in a community teaching hospital. Between October 1997 and July 2000, a review of all hospital discharges revealed 83 patients with a discharge diagnosis of "acute vascular insufficiency-intestine." Among these 83 patients, 22 cases of acute mesenteric ischemia were confirmed. Management of these 22 patients was divided into 2 groups for analysis. In Group A, 14 patients were aggressively treated with visceral angiography (n=10), visceral artery bypass (n=8), visceral embolectomy (n=4), and bowel resection (n=7). In 8 of 14 of these patients, surgical intervention occurred in less than 24 hours from presentation. In Group B, 8 patients were managed with supportive care because of advanced age (mean age = 86 +/- 7 years), comorbid conditions, or patient and family preference. Postoperative morbidity in Group A consisted of cardiac events (n=3), pulmonary insufficiency (n=5), and prolonged gastrointestinal tract dysfunction (n=3). Twelve of 14 patients in Group A survived and were discharged, whereas only 2 of 8 patients in Group B survived and were discharged from the hospital. Although the literature suggests that there can be a significant delay in the diagnosis and treatment of acute mesenteric ischemia, the early recognition and aggressive treatment of acute mesenteric ischemia resulted in a good survival rate. Supportive management of very elderly and debilitated patients needs to be considered on a case-by-case basis. Although the outlook for such patients is dismal, survivors are possible as demonstrated by this series.
Char
Daniel J
DJ
Division of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, USA.
Cuadra
Salvador A
SA
Hines
George L
GL
Purtill
William
W
D015746:Abdominal Pain / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007422:Intestines / Q000098:blood supply* / Q000000981:diagnostic imaging; D007511:Ischemia / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009518:New York; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011860:Radiography, Abdominal; D016019:Survival Analysis; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures