Acute mesenteric ischemia natural history, complications and prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby
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Overview
Natural History, Complications and Prognosis
Mortality
- The mortality associated with acute mesenteric ischemia ranges in general from 50 to 70%, which makes this disease an emergency requiring prompt diagnosis and initiation of treatment.[1]
- Acute mesenteric ischemia is associated with such an elevated mortality rate because of:
- The pathophysiology of the disease itself and effects of hypoxia on the survival of cells of the mesentery
- Delay in diagnosis
- Delay in treatment[2]
- Shown below is a graph depicting the mortality rate in acute mesenteric ischemia depending on the time of initiation of treatment.
Prognosis
The prognostic factors in acute mesenteric ischemia includes the following:
Delay in diagnosis and treatment:
The early initiation of treatment is associated with low mortality rate ranging from 0 to 10%; whereas delayed treatment beyond 24 hours from the onset of symptoms carries an elevated mortality rate that reaches 80 to 100%.[3]
Location of ischemia:
Ischemia in the peripheral portion of the mesentery are associated with worse prognosis compared to the central parts due to the presence of collaterals
Underlying cause and pathophysiology:
Non occlusive mesenteric ischemia is associated with worse prognosis compared to occlusive mesenteric ischemia because nonocclusive mesenteric ischemia usually has a non typical presentation causing delay in diagnosis and treatment.
Age of the patient:
eElderly patients have higher risk of mortality compared to younger patients.
Comorbidities
- Shown below is an image depicting bad prognostic signs in acute mesenteric ischemia.
- ↑ Acosta S: Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg 2010; 23: 4–8.
- ↑ Kortmann B, Klar E: Warum wird die mesenteriale Ischämie zu spät erkannt? Zentralbl Chir 2005; 130: 223–6.
- ↑ Paes E, Vollmar JF, Hutschenreiter S, Schoenberg MH, Schölzel E: Diagnostik und Therapie des akuten Mesenterialinfarktes. Chir Gastroenterol 1990; 6: 473–80.