Acute mesenteric ischemia natural history, complications and prognosis

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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.
Mortality in acute mesenteric ischemia
Mortality in acute mesenteric ischemia

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 ischemia in 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 a delay in diagnosis and treatment.

Age of the patient:

Elderly patients have higher risk of mortality compared to younger patients.

Comorbidities

Shown below is an image depicting bad prognostic signs in acute mesenteric ischemia.
Bad prognostic signs in acute mesenteric ischemia
Bad prognostic signs in acute mesenteric ischemia

References

  1. Acosta S: Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg 2010; 23: 4–8.
  2. Kortmann B, Klar E: Warum wird die mesenteriale Ischämie zu spät erkannt? Zentralbl Chir 2005; 130: 223–6.
  3. Paes E, Vollmar JF, Hutschenreiter S, Schoenberg MH, Schölzel E: Diagnostik und Therapie des akuten Mesenterialinfarktes. Chir Gastroenterol 1990; 6: 473–80.