Evaluation of Prognosis and Factors Influencing the Need for Second Look in Patients with Acute Mesenteric Ischemia

Abstract

Introduction: Acute mesenteric ischemia (AMI), a condition associated with high mortality risk and challenging diagnosis, typically arises due to arterial blockages in mesenteric vessels. Despite the absence of a specific diagnostic test for this condition, various markers are utilized in its diagnosis. In our study, we aimed to assess the clinical and laboratory results of patients requiring surgical intervention due to acute mesenteric ischemia. Materials and Methods: Our study included 25 patients diagnosed with acute mesenteric ischemia between January 2017 and January 2019. Demographic characteristics, comorbidities, time of hospital admission, blood parameters (leukocyte count, platelet count, amylase, lactate, arterial blood pH, bicarbonate, and lactate dehydrogenase), preoperative abdominal computed tomography results, duration of surgery, clinical course, need for secondary surgery within 48 hours postoperatively, additional resection requirement, and postoperative clinical follow-ups were recorded from hospital records. Results: The mean age of patients was 70.2±12.7 years, with a male-to-female ratio of 14/11. Eighteen patients (72%) were identified to have occlusion in the superior mesenteric artery due to thrombosis or embolism. In seven of these patients (68%), secondary surgery was required within 48 hours postoperatively, with an additional resection needed in 12 cases. The group with a fatal outcome exhibited significantly higher lactate values compared to the surviving group. Among survivors, there was a trend indicating a shorter time from emergency room admission to surgery, but no statistically significant difference was observed. In patients requiring secondary surgery, leukocyte values post the initial surgery were observed to be higher, although not significantly, compared to those not requiring additional resection. Conclusion: In elderly individuals with accompanying illnesses presenting to the emergency room with abdominal pain, the possibility of AMI should be considered. Elevated leukocyte and lactate levels may support the clinician's suspicion of AMI. Additionally, high leukocyte values in the postoperative period could serve as an indicator that ischemia may have progressed, necessitating secondary intervention. Keywords: Mesenteric ischemia, Leukocyte, Second look, Lactate

Keywords

• Mesenteric ischemia
• Leukocyte
• Second look
• Lactate

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