ACUTE MESENTERIC ISCHEMIA: CASE STUDY

• DOI: https://doi.org/10.22533/at.ed.1594762413083

• Palavras-chave: Mesenteric ischemia; Short bowel syndrome; Enterectomy; Second look

• Keywords: Mesenteric ischemia; Short bowel syndrome; Enterectomy; Second look

• Abstract:

  Introduction: Acute mesenteric ischemia is a frequently fatal surgical emergency, largely due to delayed diagnosis. Despite advances in therapy and supportive measures, the disease still persists with a high degree of morbidity and mortality, with mortality rates reaching 70% of cases. The nonspecific physical examination, uncertainty of diagnosis, the magnitude of surgeries and possible complications have contributed to limit the experience and justify the failure of treatment. Discussion: Mesenteric ischemia can be caused by arterial or venous obstruction. In the first hours, there are no signs of peritoneal irritation, distension or fever. Radiological signs are often suggestive only in advanced stages, when they reveal wall edema, abnormal separation of the loops, intestinal pneumatosis or presence of gas in the portal system.  Most patients have at least some part of the intestine frankly necrotic at the time of diagnosis. It is advisable to avoid resection of a bowel with questionable viability at the time of the first surgery. A second revision surgery “second look” can be performed, ideally 18-48 hours after the first procedure. Wide resections and discontinuity of the colon in the intestinal transit favor the establishment of short bowel syndrome, characterized by diarrhea, weight loss, dehydration, hydroelectrolytic and malabsorptive disorders. Advances in diagnostic methods, combined with advances in maintaining nutritional status, have a positive impact on the prognosis and quality of life of the patient. Conclusion: Despite the enormous advances in diagnostic methods and knowledge of its pathophysiology, the diagnosis of intestinal ischemia remains eminently clinical. The high mortality rates may be related to the difficulty in early diagnosis of intestinal ischemia, and to the lack of specificity of abdominal pain and complementary tests available. It is likely that the incidence of intestinal ischemia is higher than previously recognized.