Outcomes And Clinical Characteristics Of Transmural Intestinal Necrosis In Acute Mesenteric Ischemia

Background and objectiveAcute mesenteric ischemia(AMI)is a rare,life-threatening abdominal surgical emergency,especially for the patients with transmural intestinal necrosis(TIN).However,the optimal time of surgical intervention is controversial.As a series study,this study aimed to identify the outcomes and clinical characteristic of patients with TIN,facilitating clinical decision-making.MethodsOutcomes and clinical data of 158 patients with AMI admitted to Department of General Surgery,Jinling Hospital from January 2010 to January 2017 were reviewed retrospectively.The factors related to TIN in AMI patients were analyzed by univariate and multivariate Logistic model.ResultsAccording to the pathological evaluation and follow-up results,62 patients were TIN and 96 patients were non-TIN.Among them,there were 52 patients with arterial-derived AMI and 106 patients with venous AMI.TIN patients compared with patients with non-TIN group,repeat bowel resection,SBS,anastomotic or parastomal leakage,sepsis,ACS,gastrointestinal bleeding,ARDS,AKI,liver dysfunction,MODS and mortality were significantly increased(p<0.05).And the former had longer ICU stay and hospital stay(p<0.05).In univariate analysis,SOFA score,cause of AMI,hypertension,peritonitis,white blood cell count,CRP,total bilirubin level,albumin level,creatinine,arterial lactate,arterial PH value,free intraperitoneal fluid,decrease of bowel wall enhancement,misty mesentery and pneumatosis intestinalis are TIN risk factors(all P < 0.05).According to the binary logistic regression analysis,arterial lactic acid level(OR=4.763,95%CI: 2.293?9.897,P<0.001),free peritoneal fluid(OR=9.498,95%CI: 2.560?35.242,P=0.001)and intestinal wall gas accumulation(OR=7.081,95%CI: 1.681?29.828,P=0.008)are independent predictors of TIN in patients with AMI.The total area under the subject operating characteristic curve of this model was 0.934(95% confidence interval: 0.893?0.974).The ROC curve was used to predict the threshold of arterial lactic acid level of TIN onset was 2.65 mmol/L.ConclusionsAMI patients with secondary TIN have a higher risk of poor prognosis.The three predictors of AMI secondary TIN were arterial lactate level > 2.65 mmol /L,free peritoneal effusion and intestinal wall gas.Close monitoring of these predictors will help identify perforative intestinal necrosis and prompt surgical intervention.