[Damage control surgery for acute mesenteric ischemia].
OBJECTIVE
To examine the outcome of damage control surgery (DCS) in patients with acute mesenteric ischemia (AMI).


METHODS
Clinical data of 15 consecutive AMI cases treated with DCS from May 2001 to March 2009 at the Research Institute of General Surgery, Jinling Hospital were retrospectively analyzed. Eleven patients had acute superior mesenteric vein thrombosis (MVT) on admission, and 4 suffered from acute mesenteric arterial embolism/thrombosis (MAE/MAT). The staged damage control approach included immediate resection of the involved bowel (but no attempts to restore gastrointestinal continuity), open thrombectomy, transfer of the patients to ICU for resuscitation, and thrombolysis prior to the planned definitive reconstructive procedure.


RESULTS
Of 15 patients, 10 (66.7%) survived. The mean remnant small bowel length was (209.0+/-53.8) cm (120 to 280 cm). None of the survived patients was parenteral nutrition-dependent. Of the 5 deaths, 2 died of recurrence of thrombosis and necrosis of the remaining bowel,1 of massive gastrointestinal bleeding. One patient abandoned treatment intra-operatively, and another with total small bowel resection abandoned treatment postoperatively.


CONCLUSIONS
Damage control approach improves the survival of patients with AMI. Thrombectomy and thrombolysis are necessary for AMI management to prevent progression or further development of the thrombosis.
Gong
Jian-Feng
JF
Department of General Surgery, Jinling Hospital, Nanjing 200000, China.
Zhu
Wei-Ming
WM
Wu
Xing-Jiang
XJ
Li
Ning
N
Li
Jie-Shou
JS
D000208:Acute Disease; D000328:Adult; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007511:Ischemia / Q000601:surgery* / Q000628:therapy; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000601:surgery* / Q000628:therapy; D008643:Mesentery / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D017131:Thrombectomy; D015912:Thrombolytic Therapy