Acute mesenteric ischemia, occlisive and nonocclusive causes in elderly

Abstract

Acute mesenteric ischemia is still characterized by a high mortality since it is difficult to recognize the proper diagnosis. Unfortunately there are no guidelines based on the evidence of randomized controlled trials. Our study, like the most in literature, is a retrospective review based on the findings of ten years in patients treated at the Surgical Division of Policlinic-Vittorio Emanuele Hospital of the Catania s University for acute mesenteric ischemia. It is a typical disease affecting elderly since it s often consequence of atherosclerosis, of thromboembolism from cardiac arrhythmias and, in the nonocclusive form, of hypoperfusion caused by a low cardiac output characteristic of myocardial infarction, congestive heart failure or aortic insufficiency. Our patients with acute mesenteric ischemia were 42 but only 3 were younger than 65-year old. Habitually, the diagnosis is made intraoperatively when the bowel is already necrotic. Patients should be treated before 24 hours the onset of symptoms to improve the prognosis. CT angiography, used more and more frequently for abdominal syndromes even in small hospitals , has led to an earlier diagnosis. Moreover new endovascular techniques have to led to improved outcomes, especially when they are used in combination with open surgery techniques. Despite these advances the overall mortality remains high, in our study it was about 64% probably because our emergency operating theatres are not angio-equipped and every diagnostic and management step made in different places probably delays the appropriate successful treatment.