Abstract
Background
Early identification of patients with acute mesenteric ischemia (AMI) involving the
large bowel may play a decisive role in improving the prognosis of AMI. This study
aims to compare the outcomes between patients with isolated AMI and AMI patients with
colon involvement (CI) and to identify the predictors of worse outcomes. The different
surgical modalities for AMI patients with CI were also evaluated.
Methods
This retrospective cohort study included 199 AMI patients admitted from January 2005
to January 2014. Based on colonoscopy and pathology reports, 39 patients were diagnosed
as AMI with CI, and 160 were AMI patients without CI. The clinical outcomes and different
surgical modalities were compared. Risk factors of 30-d mortality and short bowel
syndrome (SBS) were identified.
Results
The 30-d mortality (10% versus 49%, P < 0.01) and SBS incidence (19% versus 49%, P < 0.01) were higher in AMI patients with CI than AMI patients without CI. AMI patients
with CI have higher rate of bowel resection (68% versus 95%, P < 0.001) and second-look laparotomy (25% versus 54%, P < 0.001) than patients with AMI alone. For AMI patients with CI, emergent laparotomy
was associated with shorter hospital stay (P = 0.04) and less incidence of SBS (74% versus 25%, P < 0.001) than initial endovascular therapy. Patients with ostomy had less repeated
bowel resection (11% versus 63%, P = 0.001) and rate of SBS (21% versus 79%, P < 0.001) than patients with primary bowel anastomosis. Serum procalcitonin level
and colon ischemia were risk factors of 30-d mortality and SBS for AMI.
Conclusions
AMI patients with CI represent a special cohort of AMI patients with higher risk of
poor outcome. Compared to initial endovascular therapy, emergent laparotomy was associated
with shorter length of hospital stay and reduced incidence of SBS.
Keywords
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Article Info
Publication History
Published online: August 31, 2018
Accepted:
August 2,
2018
Received in revised form:
July 16,
2018
Received:
November 15,
2017
Footnotes
S.Y. and Y.Z. were the cofirst authors.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
