Management of acute mesenteric ischemia in Assiut University Hospital: a clinical audit

Abstract

Introduction and aim Acute mesenteric ischemia (AMI) is a life-threatening condition. This is an audit for the management of a cohort of patients with AMI, which was then compared with the World Society of Emergency Surgery recommendations. Patients and methods This is a prospective clinical audit, conducted at General Surgery Department, Assiut University Hospital, Egypt, during the period from December 2017 to September 2018. The audit was designed to match the recommendations of the World Society of Emergency Surgery. Results A total of 135 patients presented with suspicion of AMI to the emergency unit of the General Surgery Department by either clinical, laboratory, or radiological findings. Only 30 (22%) patients had final diagnosis of AMI and were audited. Median age was 55 years (interquartile range, 40–66). There were 22 (73.3%) males and eight (26.7%) females. Hypertension was the most prevalent risk factor (n=10, 33.3%). Etiology was arterial embolism in 13 (43.3%), arterial thrombosis in four (13.3%), venous thrombosis in 11 (36.6%), and was not identified in two patients. Management was surgical in 17 (56.6%), interventional radiology in two (6.7%), and noninterventional in 11 (36.6%) patients. Percentages of adherence to World Society of Emergency Surgery guidelines were as follows: 40% for recommendation 1, 60% for 2, 100% for 3, 100% for 8a, 43% for 8b, 100% for 9, 100% for 10, 0% for 11, 100% for 12, and 67% for 14. Conclusion This audit showed some discrepancies between our practices and World Society of Emergency Surgery recommendations. We advocate implementing changes in our practices and reauditing.