Outcome after surgery for acute right-sided colonic ischemia without feasible vascular intervention: a single center experience of 58 patients over 6 years

BMC Surgery

Research Article

Samuel A Käser¹  Klaus-Peter Janssen¹  Jörg Kleeff¹  Helmut Friess¹  Franz G Bader¹  Christoph Späth¹  Tara C Müller¹  Anna Guggemos¹  Dirk Wilhelm¹  Ulrich Nitsche¹  Christoph A Maurer² 

[1] Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany;Hirslanden Private Clinic Group, Beausite, Schänzlihalde 11, CH-3000, Bern, Switzerland;

关键词: Non-occlusive mesenteric ischemia;    Urgent surgery;    Critically ill;   

DOI  :  10.1186/s12893-015-0018-0

 received in 2014-09-23, accepted in 2015-03-04,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe predilection site of non-occlusive mesenteric ischemia is the right-sided colon. Surgical exploration followed by segmental bowel resection and primary anastomosis or ileostomy is recommended, if vascular interventions are not feasible and conservative treatment fails. We assessed the outcome of patients in this life-threatening condition.MethodsFrom a prospective database 58 patients with urgent surgery for acute right-sided colonic ischemia without feasible vascular intervention (as a surrogate for non-occlusive mesenteric ischemia) were identified. Retrospectively the patients’ characteristics, reason for ischemia, extent of resection, rate of ileostomy creation, 30 day and one year mortality, and rate of ileostomy-reversal at one year postoperative were assessed.ResultsRadiologically mesenteric arteriosclerotic disease was present in 54% of the patients. Vaso-occlusive mesenteric disease was suspected in 15% of the patients, but not confirmed intra-operatively. Ten patients underwent (extended) right-sided hemicolectomy with primary anastomosis (30-days mortality 20%, 1-year mortality 30%). Sixteen patients had (extended) right-sided hemicolectomy with creation of an ileostomy (30-days mortality 44%, 1-year mortality 86%, ostomy reversal in one patient). Twenty-five patients had (sub-) total colectomy with ileostomy creation (30-days mortality 60%, 1-year mortality 72%, ostomy reversal in two patients). Seven patients had exploration only (30-days mortality 86%, 1-year mortality 86%). Overall, the 30-days mortality-rate was 52% and the 1-year mortality-rate was 70%. Only 7% of the patients requiring an ostomy experienced ostomy-reversal.ConclusionsPatients with urgent surgery for acute right-sided colonic ischemia without feasible vascular intervention have a very high short and long-term mortality. The rate of ostomy-reversal is very low.

【 授权许可】

CC BY   
© Käser et al.; licensee BioMed Central. 2015