Surgical management of mesenteric ischemia

Abstract

The aim of the research was to assess the initial results of the application of “Damage Control Surgery” (DCS) principle in the treatment of acute mesenteric ischemia (AMI). Despite the successes achieved in the surgical treatment of the AMI the lethality rate in this group of patients is still 70-90%. Several surgical options have been reflected until now in literature, but there are few articles on the application of DCS principle in the surgical management of AMI. We present the results of the surgical management of 13 consecutive cases of AMI treated according to the DCS management option (immediate resection of nonviable bowel without the reconstruction of the digestive tract, laparostoma, including VAC-system, stabilizing the patient in the Intensive Care department and eventual elective reconstructive surgery later) between January 2009 and march 2010. Mean age was 67.92±2.48 (48-79) years, with the mean period of time before check-in of 45.62±14.47 hours. Diagnosis was set using the results of D-dimers test, 3D-CT with angiography and laparoscopy. 11 cases of arterial AMI and 2 cases of venous AMI were identified. The primary surgery included resection of the nonviable portion of the intestine: ileum (n=2), jejunum+ileum (n=3), jejunum+ileum+right hemicolonectomy (n=8). The final reconstructive surgery was performed after 50.82± 5.31 hours. The postoperative mortality was 61.53% (died 8 patients). The initial experience demonstrates that the Damage Control Surgery principle can be considered the only surgical option for the treatment of patients with AMI. The final conclusions will be defined after the analysis of a bigger group of patients.