Acute mesenteric ischemia is still characterized by a high mortality since it is difficult to recognize the proper diagnosis. Unfortunately there are no guidelines based on the evidence of randomized controlled trials. Our study, like the most in literature, is a retrospective review based on the findings of ten years in patients treated at the Surgical Division of Policlinic-Vittorio Emanuele Hospital of the Catania s University for acute mesenteric ischemia. It is a typical disease affecting elderly since it s often consequence of atherosclerosis, of thromboembolism from cardiac arrhythmias and, in the nonocclusive form, of hypoperfusion caused by a low cardiac output characteristic of myocardial infarction, congestive heart failure or aortic insufficiency. Our patients with acute mesenteric ischemia were 42 but only 3 were younger than 65-year old. Habitually, the diagnosis is made intraoperatively when the bowel is already necrotic. Patients should be treated before 24 hours the onset of symptoms to improve the prognosis. CT angiography, used more and more frequently for abdominal syndromes even in small hospitals , has led to an earlier diagnosis. Moreover new endovascular techniques have to led to improved outcomes, especially when they are used in combination with open surgery techniques. Despite these advances the overall mortality remains high, in our study it was about 64% probably because our emergency operating theatres are not angio-equipped and every diagnostic and management step made in different places probably delays the appropriate successful treatment.
L'ischemia mesenterica acuta è caratterizzata ancora da un alta mortalità dato che è difficile formulare la diagnosi corretta. Purtroppo non esistono linee guida basate sull evidenza di dati raccolti in studi randomizzati controllati. Il nostro studio, come la maggior parte presenti in letteratura, è una revisione retrospettiva basata sui dati di dieci anni in pazienti trattati presso la Chirurgia d'Urgenza dell'Azienda Ospedaliera Policlinico-Vittorio Emanuele dell'Università di Catania per ischemia mesenterica acuta. E' una patologia tipica degli anziani dato che spesso e conseguenza di aterosclerosi, tromboembolismo secondarie ad aritmie cardiache e, nelle forme non occlusive, da ipoperfusione da bassa gittata cardiaca caratteristica di infarto del miocardio, scompenso cardiaco e insufficienza aortica. I nostri pazienti con ischemia mesenterica acuta erano 42 ma solo 3 avevano meno di 65 anni. Di solito, la diagnosi e fatta intraoperativamente quando la necrosi è già avanzata. I pazienti dovrebbero essere trattati prima entro le 24 ore dalla comparsa dei sintomi per migliorare la prognosi. L'angio-TAC, utilizzata sempre più frequentemente per patologie addominali anche negli ospedali più piccoli, ha portato ad una diagnosi più precoce. Inoltre le nuove tecniche endoscopiche hanno determinato migliori risultati, specialmente quando sono utilizzati in associazione con le tecniche di chirurgia laparotomia. Nonostante questi miglioramenti la mortalità complessiva rimane alta, nel nostro studio era di circa 64% probabilmente poiché le nostre sale operatorie d'urgenza non sono angio-equipaggiate e ogni passo sia diagnostico che terapeutico eseguito in posti diversi ritarda il trattamento efficace appropriato.
ACUTE MESENTERIC ISCHEMIA, OCCLUSIVE AND NONOCCLUSIVE CAUSES IN ELDERLY / Scapellato, Simona. - (2011 Dec 09).
ACUTE MESENTERIC ISCHEMIA, OCCLUSIVE AND NONOCCLUSIVE CAUSES IN ELDERLY
SCAPELLATO, SIMONA
2011-12-09
Abstract
Acute mesenteric ischemia is still characterized by a high mortality since it is difficult to recognize the proper diagnosis. Unfortunately there are no guidelines based on the evidence of randomized controlled trials. Our study, like the most in literature, is a retrospective review based on the findings of ten years in patients treated at the Surgical Division of Policlinic-Vittorio Emanuele Hospital of the Catania s University for acute mesenteric ischemia. It is a typical disease affecting elderly since it s often consequence of atherosclerosis, of thromboembolism from cardiac arrhythmias and, in the nonocclusive form, of hypoperfusion caused by a low cardiac output characteristic of myocardial infarction, congestive heart failure or aortic insufficiency. Our patients with acute mesenteric ischemia were 42 but only 3 were younger than 65-year old. Habitually, the diagnosis is made intraoperatively when the bowel is already necrotic. Patients should be treated before 24 hours the onset of symptoms to improve the prognosis. CT angiography, used more and more frequently for abdominal syndromes even in small hospitals , has led to an earlier diagnosis. Moreover new endovascular techniques have to led to improved outcomes, especially when they are used in combination with open surgery techniques. Despite these advances the overall mortality remains high, in our study it was about 64% probably because our emergency operating theatres are not angio-equipped and every diagnostic and management step made in different places probably delays the appropriate successful treatment.File | Dimensione | Formato | |
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