Summary
Acute mesenteric ischemia is commonly seen in old patients. This study was undertaken to show that mesenteric ischemia might be seen in individuals under 40 years of age and that its diagnosis is challenging. Twenty-six patients with acute mesenteric ischemia under the age of 40 were studied. The main symptom on admission was abdominal pain. Symptom duration varied between 12 h and 5 days. The medical history of the patients revealed that 9 had no previous diseases. Other 17 had predisposing factors in the first evaluation. None of the patients had any history of narcotic or drug abuse. Ten patients presented with signs and symptoms of sepsis and septic shock. Preoperative diagnosis was acute intestinal ischemia only in 6 patients. Preoperatively, all the patients had intestinal or colonic ischemia and necrosis; one had additional ischemia of the liver, stomach, duodenum, and pancreas. Six patients had massive intestinal necrosis. The overall postoperative complication and overall mortality rates were 61.5 and 26.9 %, respectively. Complications and mortality were determined to be associated with previous pulmonary disease, acidosis, presence of septic shock, acute renal failure, extent of the ischemia and extent of resection, second look operations, previous cardiac events, and the kind of affected bowel (colon involvement).
Zusammenfassung
Die akute mesenteriale Ischämie wird häufig bei älteren Patienten beobachtet. Diese Studie wurde durchgeführt um zu zeigen, dass mesenteriale Ischämie auch bei Personen unter 40 Jahren auftreten kann und dass ihre Diagnose schwierig ist. Es wurden die Daten von 26 Patienten mit einer akuten mesenterialen Ischämie und einem Alter unter 40 Jahren analysiert. Das Hauptsymptom bei der Aufnahme waren Bauchschmerzen; die Symptomdauer variierte zwischen 12 Stunden und 5 Tagen. Die Krankengeschichte der Patienten ergab, dass neun Patienten keine Vorerkrankungen hatten. Weitere 17 wiesen prädisponierende Faktoren auf; keiner der Patienten hatte eine Vorgeschichte von Betäubungsmittel- oder Drogenmissbrauch. Zehn Patienten hatten Anzeichen und Symptome der Sepsis oder des septischen Schocks. Nur bei sechs Patienten lautete die präoperative Diagnose „akute intestinale Ischämie“. Perioperativ hatten alle Patienten eine Darmischämie oder -nekrose, einer hatte zusätzlich eine Ischämie der Leber, des Magens, des Zwölffingerdarms und der Bauchspeicheldrüse. Sechs Patienten hatten eine massive intestinale Nekrose. Die Rate von postoperativen Komplikationen betrug 61,5 %, die Mortalität 26,9 %. Komplikationen und Sterblichkeit waren mit einer früheren Lungenerkrankung, der Azidose, dem Vorhandensein des septischen Schocks, dem akuten Nierenversagen, dem Ausmaß der Ischämie und dem Ausmaß der Resektion, „Second look“ Operationen, früheren kardialen Ereignissen und der Kolon-Beteiligung assoziiert.
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Ozturk, G., Aydinli, B., Atamanalp, S. et al. Acute mesenteric ischemia in young adults. Wien Med Wochenschr 162, 349–353 (2012). https://doi.org/10.1007/s10354-012-0120-1
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DOI: https://doi.org/10.1007/s10354-012-0120-1