Shilpa Mariappa Casaba

Acute mesenteric ischaemia is a life-threatening abdominal emergency. It may be the result of an arterial or venous occlusion, a vasospasm secondary to low-flow states in ICU patients. The overall incidence is 1 in 1000 hospital admissions. The objective of this descriptive study was to determine the clinical presentations and outcome after surgery of patients with acute mesenteric ischaemia. It was conducted in Department of Surgical Gastroenterology and Liver Transplantation, BMCRI, Bangalore.
Descriptive study of all patients having operative diagnosis of acute mesenteric ischaemia from June 2009 to December 2016 were included.
Total of 31 patients were studied. Their mean age was 60.12 years, 17 were males and 14 were females. Mean BMI was 32.4. Abdominal pain was present in 26 patients, vomiting in 21 and anorexia in 13 patients. Abdominal tenderness was present in 21 patients, abdominal distension and rebound tenderness in 18 patients. Eighteen patients had hypertension, 10 had coronary artery disease and 20 had diabetes mellitus. Eight patients were in haemodynamic instability and 4 patients in renal failure. Except one patient, all underwent CECT abdomen and pelvis. Four patients were managed conservatively with close monitoring after diagnostic laparoscopy. Resection of bowel was done in 27 patients. Two cases had re-exploration. Nine patients deteriorated haemodynamically as sepsis was irreversible and died subsequently. Common immediate postoperative complications are wound infection, dehiscence, pneumonia, septicaemia and MODS. On followup at 1 month, 9 patients were seen with improved nutritional status without any complications. The common complications noted at 1st month are persistent diarrhoea, deep wound infection, stromal complications, respiratory infection, melena, etc.

Acute Mesenteric Ischaemia (AMI) is a common condition at a GI referral centre. It is commonly distributed among elderly men and women with pre-existing risk factors. The prognosis depends upon time at presentation, general condition at presentation, associated risk factors, extent of bowel gangrene and extent of bowel resected. In high-risk patients with pain abdomen of unexplained cause, we should have a low threshold for diagnosing acute mesenteric ischaemia as our study showed PPV clinical diagnosis of AMI is 57%.Timely diagnosis will prevent the progression of bowel gangrene and early surgical intervention is warranted for better clinical outcome.