DOI: http://dx.doi.org/10.18203/2349-2902.isj20190474

Acute mesenteric artery occlusion in hypobaric oxygen environment

Mohammed Al-Saeed

Abstract


Background: Acute mesenteric ischemia represents a challenge in Taif and related districts where hypobaric oxygen may add to other risk factors as prevalence of diabetes mellitus and obesity. The aim of this retrospective study was to record and discuss the underlying risk factors, pattern of presentation, methods of diagnosis and results of treatment of acute mesenteric ischemia in Taif Tertiary Hospitals.

Methods: In this chart review and database study, thirty-one patients met the inclusion criteria in the period from January 2009 to December 2017. The outcomes included demographics, risk factors, clinical findings, diagnostic and therapeutic methods, in addition to the mortality and follow up of the study population.

Results: The commonest presenting symptom was abdominal pain (100%), of them 45.2% had marked peritoneal signs.  Diagnosis was established by CT angiography in 41.9% and after exploratory laparotomy in 58.1% of patients. Mesenteric artery thrombosis was the cause in 64.5% and embolism in 35.5%. In all patient’s necrotic bowel segments were resected followed by revascularization. Reoperation was performed in 32.3% of patients. Perioperative deaths were 41.9% and the overall mortality 58.1%.

Conclusions: The findings of this study are not quite different from that performed on population living in normobaric oxygen environment except for a higher incidence of arterial thrombosis. Validation of these findings needs more standardized large prospective studies to avoid the impact of different confounding factors and the limited statistical power related to small sample sizes.


Keywords


Acute mesenteric ischemia, Hypobaric oxygen, Mesenteric artery thrombo-embolism

Full Text:

PDF

References


Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017;12(1):38.

Bala M, Kashuk J, Moore EE, Catena F, Leppaniemi A, Ansaloni L, et al. Establishing position papers by the WSES. World J Emerg Surg. 2018;13(1):1.

Clair DG, Beach JM. Mesenteric ischemia. New Eng J Med. 2016;374(10):959-68.

Acosta S, Björck M. Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well-defined population. Euro J Vascular Endovascular Surg. 2003;26(2):179-83.

Al-Saeed M, Shady MA, Hatem M, Alzahrani K, Al-Nashar M, Al Nashar H. Acute occlusive mesenteric ischemia in Taif Province, Saudi Arabia. Egypt J Hospital Med. 2012;47: 158– 65.

Al-Shraim MM, Zafer MH, Rahman GA. Acute occlusive mesenteric ischemia in high altitude of southwestern region of Saudi Arabia. Ann African Med. 2012;11(1):5.

Ritz JP, Germer CT, Buhr HJ. Prognostic factors for mesenteric infarction: multivariate analysis of 187 patients with regard to patient age. Ann Vascular Surg. 2005;19(3):328-34.

Endean ED, Barnes SL, Kwolek CJ, Minion DJ, Schwarcz TH, Mentzer RM. Surgical management of thrombotic acute intestinal ischemia. Ann Surg. 2001;233(6):801.

Huerta C, Rivero E, Montoro MA, García‐Rodriguez LA. Risk factors for intestinal ischaemia among patients registered in a UK primary care database: a nested case–control study. Alimentary Pharmacol Therapeutics. 2011;33(8):969-78.

Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Seminars Vascular Surg. 2010;23(1):4-8.

Tilsed JV, Casamassima A, Kurihara H, Mariani D, Martinez I, Pereira J, Ponchietti L, et al. ESTES guidelines: acute mesenteric ischaemia. Euro J Trauma Emerg Surg. 2016;42(2):253-70.

Chait A, Bornfeldt KE. Diabetes and atherosclerosis: is there a role for hyperglycemia?. J Lipid Res. 2009;50:S335-9.

Bendz B, Rostrup M, Sevre K, Andersen TO, Sandset PM. Association between acute hypobaric hypoxia and activation of coagulation in human beings. Lancet. 2000;356(9242):1657-8.

Yasuhara H. Acute mesenteric ischemia: the challenge of gastroenterology. Surg Today. 2005;35(3):185-95.

Nuzzo A, Maggiori L, Ronot M, Becq A, Plessier A, Gault N, et al. Predictive factors of intestinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center. Am J Gastroenterol. 2017;112(4):597.

Evennett NJ, Petrov MS, Mittal A, Windsor JA. Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia. World J Surg. 2009;33(7):1374-83.

Powell A, Armstrong P. Plasma biomarkers for early diagnosis of acute intestinal ischemia. Seminars Vascular Surg. 2014;27(3-4):170-175.

Treskes N, Persoon AM, Zanten AR. Diagnostic accuracy of novel serological biomarkers to detect acute mesenteric ischemia: a systematic review and meta-analysis. Inter Emerg Med. 2017;12(6):821-36.

Altinyollar H, Boyabatli M, Berberoğlu U. D-dimer as a marker for early diagnosis of acute mesenteric ischemia. Thrombosis Res. 2006;117(4):463-7.

Rosow DE, Sahani D, Strobel O, Kalva S, Mino-Kenudson M, Holalkere NS, et al. Imaging of acute mesenteric ischemia using multidetector CT and CT angiography in a porcine model. J Gastrointestinal Surg. 2005;9(9):1262-75.

Wyers MC. Acute mesenteric ischemia: diagnostic approach and surgical treatment. Seminars Vascular Surg. 2010;23(1):9-20.

Berland T, Oldenburg WA. Acute mesenteric ischemia. Current Gastroenterol Rep. 2008;10(3):341.

Huang HH, Chang YC, Yen DH, Kao WF, Chen JD, Wang LM, et al. Clinical factors and outcomes in patients with acute mesenteric ischemia in the emergency department. J Chin Med Assoc. 2005;68(7):299-306.

Silvestri L, Saene HK, Zandstra DF, Marshall JC, Gregori D, Gullo A. Impact of selective decontamination of the digestive tract on multiple organ dysfunction syndrome: systematic review of randomized controlled trials. Crit Care Med. 2010;38(5):1370-6.

Urbanavičius L, Pattyn P, Putte D, Venskutonis D. How to assess intestinal viability during surgery: a review of techniques. World J Gastrointestinal Surg. 2011;3(5):59.

Horgan PG, Gorey TF. Operative assessment of intestinal viability. Surg Clin North Am. 1992;72(1):143-55.

Park WM, Gloviczki P, Cherry Jr KJ, Hallett Jr JW, Bower TC, Panneton JM, et al. Contemporary management of acute mesenteric ischemia: factors associated with survival. J Vascular Surg. 2002;35(3):445-52.

Corcos O, Nuzzo A. Gastro-intestinal vascular emergencies. Best Prac Res Clin Gastroenterol. 2013;27(5):709-25.

Inderbitzi R, Wagner HE, Seiler C, Stirnemann P, Gertsch P. Acute mesenteric ischaemia. Euro J Surg. 1992;158(2):123-6.

Sise MJ. Mesenteric ischemia: the whole spectrum. Scandinavian J Surg. 2010;99(2):106-10.

Freitas B, Bausback Y, Schuster J, Ulrich M, Bräunlich S, Schmidt A, et al. Thrombectomy devices in the treatment of acute mesenteric ischemia: initial single-center experience. Ann Vascular Surg. 2018.

Jia Z, Jiang G, Tian F, Zhao J, Li S, Wang K, et al. Early endovascular treatment of superior mesenteric occlusion secondary to thromboembolism. Euro J Vascular Endovascular Surg. 2014;47(2):196-203.

Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Brit J Surg. 2014;101(1):e109-18.

Yanar H, Taviloglu K, Ertekin C, Ozcinar B, Yanar F, Guloglu R, et al. Planned second-look laparoscopy in the management of acute mesenteric ischemia. WJG. 2007;13(24):3350.

Schoots IG, Koffeman GI, Legemate DA, Levi M, Van Gulik TM. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Brit J Surg. 2004;91(1):17-27.

Haghighi PH, Lankarani KB, Taghavi SA, Marvasti VE. Acute mesenteric ischemia: causes and mortality rates over sixteen years in southern Iran. Ind J Gastroenterol. 2008;27(6):236-8.

Wadman M. Survival after operations for ischaemic bowel disease. Euro J Surg. 2000;166(11):872-7.