Predictors of mortality in acute mesenteric vascular ischemia with bowel gangrene

Abstract

Background: Acute mesenteric vascular event can be thrombotic, embolic, vasospatic, or venous thrombosis. These patients present with nonspecific signs disproportionate to symptoms making early diagnosis difficult. Mortality remains high (30-100%). This prompted us to undertake this study to find predictors of mortality in these patients.Methods: This was prospective non-study carried out at our tertiary referral hospital over defined period of 22 months during which all patients operated for acute mesenteric ischemic bowel gangrene were included. Variable data regarding demographics, clinical and biochemical parameters, operative findings and their association with mortality was recorded in predesigned case sheets. Chi-square test was applied to determine significance.Results: Advanced age, presence of co-morbid conditions, delayed (>24 hours) presentation, hypotension, tachypnea, hypoxia, more than two system failures, more than three feet length of resected gangrenous bowel, < 100 cms of remnant viable bowel, need for second look surgery, complications of surgery and more than one mesenteric arterial involvement are negative predictors of mortality. Whereas laboratory parameters like haemoglobin, leucocyte count, serum creatinine and metabolic acidosis have no statistically significant correlation to mortality. Similarly presence of perforation of gangrenous intestine, ileocaecal resection, amount of contamination have no effect on morality rate.Conclusions: One of the reasons for persistant high mortality of this disease is it’s occurance in higher age group and frequent association with comorbidities. Difficulties in diagnosis leads to delayed treatments; adding to mortality burden. Mesenteric angiography is underutilised diagnostic tool. Endovascular revascularisation procedures are not widely available and many patients are unsuitable due to clinical condition and risk of reperfusion injury. In presence of peritoneal signs and suspicion of disease urgent exploratory laparotomy is the gold standard.