Clinical Report: Outcomes and Features in Acute Mesenteric Ischemia Surgery

Overview

This retrospective cohort study analyzed 53 patients with intraoperatively verified acute mesenteric ischemia (AMI) undergoing emergency surgery. The majority had arterial thrombosis or embolism, with high comorbidity rates and significant delays in surgery for transferred patients. Mortality remains high, emphasizing the need for timely diagnosis and intervention.

Background

Acute mesenteric ischemia is a rare but life-threatening abdominal emergency caused by sudden interruption of blood flow to the small intestine, often due to embolic occlusion of the superior mesenteric artery. Early diagnosis is challenging due to nonspecific symptoms and lack of early peritonitis signs. Computed tomography angiography is the diagnostic gold standard, and emergency surgery with revascularization and resection of necrotic bowel is the mainstay of treatment. Despite advances, mortality rates can reach up to 70%, particularly with delayed diagnosis and treatment.

Data Highlights

Key Findings

• Among 53 patients with confirmed AMI, arterial thrombosis (43%) and embolism (40%) were the predominant causes.
• Most patients had significant cardiovascular comorbidities, including arterial hypertension and atrial fibrillation.
• 87% of patients were transferred from other hospitals, often with significant delays between CT diagnosis and surgery.
• Transferred patients experienced a significantly longer time interval from CT scan to surgery compared to directly admitted patients (492 vs. 167 minutes, p < 0.001).
• Empirical antibiotic therapy was administered preoperatively in 72% of patients, mainly penicillin with β-lactamase inhibitors.
• Diagnosis was primarily confirmed by CT angiography in 94% of cases, underscoring its role as the diagnostic gold standard.

Clinical Implications

Early recognition and rapid surgical intervention are critical to improving outcomes in AMI. Delays associated with inter-hospital transfers significantly prolong time to surgery and may worsen prognosis. Empirical antibiotic therapy should be considered promptly after diagnosis. Clinicians should maintain a high index of suspicion in elderly patients with cardiovascular comorbidities presenting with abdominal pain.

Conclusion

This study highlights the high morbidity and mortality associated with AMI and the impact of delayed surgery, particularly in transferred patients. Optimizing early diagnosis and minimizing treatment delays are essential to improve survival.

References

1. Author/Source/Year -- Patient Outcomes and Clinical Features in Acute Mesenteric Ischemia: A Retrospective Cohort Study