Abstract

Aim: To analyse the clinical factors affecting the outcomes of patients with AMI.

Material and Methods: Clinical data of 11 patients with AMI with gut gangrene were analysed.  Presentation, operative findings, peri-operative morbidity and complications were analysed.

Results: Pain abdomen, vomiting & distension were common symptoms while few presented with hematemesis, malena, jaundice and fever. X-ray abdomen and chest were suggestive of dilated bowel loops and pleural effusion while CECT abdomen had dilated thickened bowel loops, ascites and in few thrombosis of SMA. The mean interval between onset of symptoms to surgical intervention was 4.6 days due to delayed presentation as well as diagnosis. Ten patients underwent gut resection and ileostomy/jejunostomy while 01 patient underwent resection anastomosis. Seven patients required major bowel resection (> 150 cm) and 04 patient required segmental bowel resection. Six patients required ICU care > 07 days for inotropic and/or ventilatory supports. Post-operative, nutritional and fluid management was achieved with TPN, IV fluids, re-feeding of jejunal output. Six patient survived > 30 days. Early mortality (< 30 days) was due to sepsis, frequent dehydration, PTE and multi-organ failure while late mortality (> 30 days) was due to entero-cutaneous fistula, central line thrombosis and sepsis.

Conclusion: AMI has high morbidity and mortality.  The management is delayed due to initial non-specific presentation. Imaging like CECT abdomen is helpful in late stage. Extent of bowel resection and proximal remaining jejunum has adverse effect on outcome. Early diagnosis and intervention can reduce sepsis related early mortality.

Keywords: Gut gangrene, Acute Mesenteric Ischemia, AMI