Publication:

Mesenteric vascular ischemia: an observational prospective study

Background Mesenteric ischemia is a rare but life-threatening condition with high morbidity and mortality. Variable aetiology and nonspecific presentation frequently delay management. This study evaluated morbidity and mortality outcomes in patients with mesenteric vascular ischemia at a tertiary care centre.

Methods A prospective observational study was conducted with patients with mesenteric ischemia, categorised as acute, acute-on-chronic, or chronic. Demographic, clinical, radiological, and treatment data were analyzed, with outcomes compared between arterial and venous ischemia. Follow-up was performed at 2 and 6 months post-discharge.

Results Thirty-three patients were included (25 males, 8 females), with 46% aged 30–45 years. Acute mesenteric ischemia was most common (n=27), followed by acute-on-chronic (n=4) and chronic ischemia (n=2). Diabetes mellitus was the most common comorbidity, and smoking was the most common risk factor. Abdominal pain was present in 96.9% of patients, while one-third presented with peritonitis. Leucocytosis was observed in 76%, and elevated D-dimer levels in 91%. Computed tomography (CT) angiography identified arterial thromboembolism in 25 patients, venous thrombosis in 5, volvulus-related SMA occlusion in 1, and median arcuate ligament syndrome in 2. Mortality was 85.7% in patients requiring >200 cm bowel resection and 70% in those with <100 cm resected. Overall, 6-month mortality was 48.48%, with a mean hospital stay of 19.3 days.

Conclusions Mesenteric ischemia requires a high index of suspicion for early diagnosis. CT angiography is the diagnostic modality of choice. Outcomes are better in chronic ischemia, while acute-on-chronic presentations have the worst prognosis.