title: Local thrombolytic therapy in acute mesenteric ischemia.
abstract: BACKGROUND
  The aim of the study was to evaluate the local thrombolytic therapy (LTT) in combination with laparoscopy, in management of acute mesenteric ischemia (AMI).
  
  
  METHODS
  From January 2000 to January 2010, patients who were admitted to the hospital with AMI due to acute arterial occlusion were analysed retrospectively. Patients presenting with acute abdomen with a suspicion of AMI were evaluated with computerized tomography angiography (CTA). Patients who had findigs of AMI on CTA, were underwent selective mesenteric angiography and LTT eventhough without peritoneal signs. LTT was carried out before or after laparoscopy or laparotomy, and initiated with recombinant plasminogen activator.
  
  
  RESULTS
  LTT was performed in 13 (17.1%), out of 76 patients. From the remaining patients, 56 underwent necrotic bowel resection and 7 underwent tromboembolectomy. The median age was 62 years (45-87). The median duration of symptoms was 24 h. Four (30.7%) patients presented within 24 h onset of symptoms, whilst 9 (69.3%) patients presented after 24 h onset of symptoms. There were 5 (39.5%) patients, who presented with abdominal pain without peritoneal signs on physical examination and 8 (61.5%) patients, who had peritoneal signs. The mortality rate was 20% (1/5) in the first group who presented without peritoneal signs, whilst it was 62.5% (5/8) in the remaining.
  
  
  CONCLUSIONS
  Early intervention in AMI is the key to better results. CTA combined with early laparoscopy and LTT may have beneficial effects at this setting.
authors: Istanbul Medical Faculty, Department of General Surgery, Istanbul University, Istanbul, Turkey. yanar_fatih@yahoo.com.
authors: Fatih
authors: F
authors: Yanar
authors: Orhan
authors: O
authors: Agcaoglu
authors: Inanc Samil
authors: IS
authors: Sarici
authors: Emre
authors: E
authors: Sivrikoz
authors: Adem
authors: A
authors: Ucar
authors: Hakan
authors: H
authors: Yanar
authors: Murat
authors: M
authors: Aksoy
authors: Mehmet
authors: M
authors: Kurtoglu
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