[Acute mesenteric ischemia: study of predictive factors of mortality].
BACKGROUND
Acute mesenteric ischemia is a surgical emergency that requires a quick diagnosis and therapeutic care. Without treatment, the outcome is towards intestinal infarction whose prognosis remains grim.


OBJECTIVE
To look for predictive factors of mortality of this disease.


METHODS
We retrospectively reviewed the clinical data of patients hospitalized between January 2000 and December 2008 for acute mesenteric ischemia. Univariate and multivariate analysis of factors that could influence mortality was conducted.


RESULTS
26 patients, predominantly male, were included. The mean age was 60 years. These patients were cared for on average 4 days after the onset of symptoms. The diagnosis was made pre-operatively in 9 patients, by CT scan in 8 patients and by Doppler ultrasound in 1 patient. The cause of AMI was arterial thrombosis in 19 cases, venous thrombosis in 4 cases and non occlusive mesenteric ischemia in 3 cases. 25 patients were operated on emergency 24 times by a laparotomy and one time by a laparoscopy. The surgery consisted in bowel resection in 15 patients; an abstention was decided in one case of venous mesenteric ischemia and in 9 cases where necrosis affected all small bowels. Revascularization of the superior mesenteric artery was associated in 4 cases. Outcome was simple in 8 patients. The mortality rate was 69%, death occurred in a period of J0 to J90 after surgery. This rate wasn't influenced by age or sex. It was higher in patients with preoperative collapse (p = 0.02) and having an expansive bowel necrosis (p=.0001). The prognosis is better in cases of venous infarction with a mortality rate of zero.


CONCLUSIONS
Prognosis of acute mesenteric ischemia depends on the aetiology and the quickness of treatment. It is directly linked to the extension of intestinal infarction. An urgent and multidisciplinary care is necessary.
Service de Chirurgie, Hopital Habib Thameur. Tunis, Tunisie
Fatma
F
Aouini
Ahmed
A
Bouhaffa
Jaouhar
J
Baazaoui
Slim
S
Khelifi
Anis
A
Ben Maamer
Noomen
N
Houas
Abderraouf
A
Cherif
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality*; D008297:Male; D065666:Mesenteric Ischemia; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000401:mortality*