The Resarch Of Predictive Factors Of Acute Mesenterc Ischemic Necrosis

Objective:Acute mesenteric ischemia(AMI)is a serious and potentially fatal condition.AMI is an acute vascular emergency of the small intestine that can extend to involve parts of the colon as well.The inadequate blood flow through the mesenteric blood vessels compromises the vitality of the intestine causing a state of reversible ischemia that,if not promptly corrected,may progress to irreversible tissue damage and gangrene.AMI is a potentially life threatening condition with mortality rates ranging from 32 to 86%.The outcome of AMI depends on the development and extent of irreversible bowel necrosis which necessitates immediate resection of the affected bowel loops,the resection can sometimes be extensive leading to the development of short bowel syndrome.No defifinite parameter can predict transmural bowel necrosis in patients with AMI to justify early surgical intervention.The current study aimed to identify the clinical,laboratory,and radiologic parameters that can successfully predict the onset of intestinal transmural necrosis in patients with AMI.The primary goal in the management of AMI is to prevent progression of reversible bowel ischemia to irreversible necrosis.It has been demonstrated that the ischemic insult of AMI can be reversed and that bowel necrosis could be deemed a late complication of the disease.Preservation of the bowel viability would serve to decrease the need for bowel resection and improve the outcome and survival of the patients.The decision making in AMI can sometime be cumbersome with the surgeon on the horns of a dilemma trying to avoid unnecessary operation in patients with ischemic,yet still viable intestine and to avoid delay in the operative management of patients with irreversible bowel damage.Methods:Records of patients who visited the affiliated hospital of Qingdao university from January 2014 to December 2018 were reviewed.Clinical parameters as patients' symptoms,vital signs,and signs of peritonitis along with the results of laboratory and radiologic investigations were analyzed to identify predictive factors for intestinal transmural necrosis using binary logistic regression analysis.Results:Ninty seven patients(52 males)with mean age of 55 years were included.Venous occlusion was the cause of AMI in 35 patients and arterial occlusion in 62 patients.21 patients completed conservative treatment successfully,whereas 76 patients required exploratory laparotomy.On laparotomy,six patients were found to have viable bowel.Overall,27 patients had viable bowel and 70 had bowel necrosis.The signifificant independent predictors for transmural bowel necrosis were mesenteric arterial occlusion(OR:26.5,p = 0.02),leukocytosis(OR: 1.31,p<0.001),acidosis(OR: 3.81,p = 0.04),free intraperitoneal flfluid(OR: 4.21,p = 0.005)Conclusion:The independent predictors for transmural bowel necrosis were mesenteric arterial occlusion,leukocytosis,acidosis,free intraperitoneal flfluid.Intestinal necrosis in acute mesenteric vascular occlusive diseases prompts a poor prognosis.Surgeons should be alert to the occurence of intestinal necrosis and should perform laparotomy promptly in order to take suitable management.