Diagnosis And Treatment For 23 Cases Of Acute Mesenteric Ischemia

Objective:To investigate the clinical features, diagnosis and surgical treatment of acute mesenteric ischemia.Methods:A retrospective analysis of acute mesenteric ischemia was made by collecting 23 patients information who were treated in The Second Affiliated Hospital of Dalian Medical University from January 2002 to December 2010.Results: There were 11 males and 12 females patients with the mean age of 65 years. 21 cases had associated with heart disease, 12 cases with hypertension, 7 cases with diabetes, 8 cases with surgery history and lacunar cerebral infarction appeared in 2 cases. 83%(19/23)patients had manifestation of abdominal pain, bloating, nausea, vomiting, blood stool and 56.5%(13/23)cases had emerged with signs of peritonitis stimulaiton. According to the laboratory tests, the ratio of elevated white blood cell was 78.3% and neutrophil was 73.9%, respectively. The appearance ratio of D-dimmer masculine was 66.7%(2/3). In imaging examinations, the diagnosis was positive in color dopplar ultrasound of 37.5% (3/8) and in CT examination of 75% (3/4), 1 case was diagnosed as mesenteric artery thrombosis followed by routine mesenteric angiography (DSA) check, The diagnosis rate by abdominal surgical exploration was 56.5% (13/23). In 23 cases, the primary accurate rate of diagnosis was 21.8% (5/23) and the misdiagnostic rate was 78.3% (18/23). The treatment included drug therapy and surgery treatment. 6 patients were treated conservatively with papaverine by simple expansion or heparin anticoagulation etc, 1 patient was unhealed with the result of discharging from hospital , 5 cases were died;1 case was improved and discharged by balloon dilation treatment. The remaining 16 patients underwent surgical treatment combined with systemic therapy and were applied with an appropriate amount of vasodilator, anticoagulant and thrombolytic agent for preoperative, intraoperative and postoperative. 4 patients were operated by routine partial small bowel resection, 6 underwent most of the small bowel resection, 3 cases were conducted with most of the small intestine resection and right hemicolectomy, 1 patient was received regular transverse colon resection, and 1 underwent the transverse colon resection along with routine part of small intestine. The above patients were cured and discharged except for 1 case death because of the necrotic bowel without capable removal situation. In this group 69.6% (16/23) of patients underwent surgery treatment and cure rate was 93.8% (15/16). 1 case was associated with short bowel syndrome postoperatively. The complication appearance rate was 6.67%(1/15). Mortality rate reached 26.1 (6/23).Conclusions: Being lack of typical clinical features and specificity and sensitivity examination way, the mortality of AMI is still high. Early diagnosis and right treatment is the key to reduce mortality.