Clinical spectrum and surgical management of acute mesenteric ischaemia in Singapore

Sreedharan S, Tan YM, Tan SG, Soo KC, Wong WK
Correspondence: Dr Tan Yu Meng, gsutym@sgh.com.sg

ABSTRACT
Introduction Acute mesenteric ischaemia (AMI) is a surgical emergency with a dismal prognosis. Much of the literature concerning this condition is from the West. This study aims to present a single-centre Asian experience of management of patients with AMI and the immediate outcome following surgical treatment.
Methods This is a retrospective study of patients managed for AMI in our department between 1990 and 2003. The data was obtained from a prospectively-collected surgical data base as well as from clinical case records.
Results 65 patients were managed by our department for AMI over 14 years. The median age of this patient group was 69 years, with a high prevalence of cardiovascular diseases. The majority of patients presented with abdominal pain, distension and vomiting. The commonest subtype of AMI was caused by mesenteric arterial occlusion; this subtype also had the highest in-hospital mortality. Our overall in-hospital mortality for all 65 patients was 55.4 percent.
Conclusion Clinical suspicion, especially in a patient with the relevant risk factors, remains the mainstay of appropriate early management of AMI. Our patient demographics, coexistent diseases and commonest subtype of AMI were similar to that reported in the Western literature. In this paper, we also suggest a management algorithm for patients with suspected AMI.

Keywords: acute abdomen, acute mesenteric ischaemia, mesenteric arterial occlusion, surgical emergency
Singapore Med J 2007; 48(4): 319–323