Survival after Operations for Ischaemic Bowel Disease

Wadman, Maria; Syk, Ingvar; Elmståhl, Sölve

doi:10.1080/110241500447263

Cited by 75 publications

(55 citation statements)

References 11 publications

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“…The peri-operative factors predicting mortality after mesenteric ischemia have been extensively studied [7,99] . Of the various factors examined, age > 70 (where diagnosis is more frequently overlooked), and prolonged duration of symptoms were independent predictors of mortality [97,[102][103][104] . It cannot be overemphasized that a high index of suspicion, prompt diagnosis and aggressive early treatment are the only surgeon-dependent factors that have a positive influence on the outcome.…”

Section: Outcomementioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, is the only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

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Section: Outcomementioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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“…It is unlikely that the finding of an ischemic intestine in two octogenarians would have altered their clinical management. The prognosis of this disease in the aged patient is, despite the possibility of surgical therapy, almost always poor [19]. Consequently, in our selected group of patients admitted with a hip fracture, the causes of death and treatment failures could be identified without the need for autopsy.…”

Section: Discussionmentioning

confidence: 98%

Mortality Registration in Patients with a Proximal Femoral Fracture Admitted to a Surgical Ward

Tjeenk¹,

Schepers²,

Linde³

et al. 2002

Eur J Trauma

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“…In ca. 40% der Patienten liegen anamnestisch Anzeichen einer chronischen intestinalen Ischämie vor (Tabelle 3) [45,67]. Obwohl Autopsiestudien belegen, dass bei 2/3 aller >80-Jäh-rigen eine Stenose der AMS vorliegt, beträgt das Durchschnittsalter der Patienten in aktuellen Untersuchungen nur etwa 60 Jahre, Frauen sind dabei häufi-ger betroffen (Verhältnis Männer/Frauen 1:1,5-3).…”

Section: äTiologieunclassified

Die akute mesenteriale Ischämie

Eckstein

2003

Chirurg

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Acute mesenteric ischemia represents an intensive medical emergency which, when untreated, leads to sepsis and multiorgan failure. Predictive factors for survival are the time duration between onset of symptoms and therapy, etiology,patient age, and immediate therapy with anticoagulants in case of acute mesenteric thrombosis. Pathologically raised laboratory parameters (lactate, acidosis, leukocytosis) are signs of advanced mesenteric ischemia. Therapy aims at reinstating arterial perfusion of ischemic and potentially life-threatening intestinal regions and at avoiding further ischemias or infarctions. Immediate vessel reconstruction (embolectomy, thrombectomy,TEA,bypass) can prevent mesenteric infarction and is therefore preferable to intestinal resection alone, as long as irreversible ischemia or sepsis are not present. If the degree of reperfusion is in question, the indication for "second-look laparotomy" is to be used generously.

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Survival after Operations for Ischaemic Bowel Disease

Abstract: Advanced age was a strong risk factor for death after operation for ischaemic bowel disease, and there was a higher incidence of unresectable gangrene. Delay in surgical intervention was associated with increasing mortality.

Cited by 75 publications

References 11 publications

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Mortality Registration in Patients with a Proximal Femoral Fracture Admitted to a Surgical Ward

Die akute mesenteriale Ischämie

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