Outcomes of Patients with Acute Mesenteric Ischemia Treated in Two Large Multidisciplinary Third-Level Hospitals of the Ryazan Region

Abstract Acute mesenteric ischemia is still a complex unresolved problem in surgery, as evidenced by the high mortality rates and postoperative complications in this cohort of patients.

The aim of the study was to evaluate outcomes of patients with acute mesenteric ischemia (AMI) treated in two hospitals – Regional Clinical Hospital and City Clinical Hospital of Emergency Medical Care – in the Ryazan region in 2022–2023.

Material and methods A retrospective analysis of 53 medical records of patients undergoing surgery with a diagnosis of acute mesenteric ischemia (K55.0) was conducted.

Results The average age of patients was 73.5 years (60.3% women). The overall postoperative survival rate was 52.8% (n=27). Late hospitalization was noted: the average time from illness onset to admission was 21 hours, only 11.3% of patients were admitted within the “therapeutic window” (up to 6 hours). The diagnosis was correctly established upon admission in only 50.8% of cases, and intraoperatively in 46.6% of patients. Prehospital diagnosis was virtually nonexistent (2.6%). In the prehospital stage, AMI was most often masqueraded as acute intestinal obstruction (28.3%) and peritonitis (13.2%). The main risk factors were coronary heart disease (93.4%), hypertension (88.6%), and arrhythmia (75.4%). Bowel resection was performed in 52.8% of patients, primarily in the superior mesenteric artery (92.8%). Laboratory diagnostics were nonspecific, and ultrasound and radiography revealed only indirect signs of complications, without influencing early verification of thrombosis.

Discussion The main problem remains late diagnosis and a lack of vigilance, leading to the development of irreversible intestinal necrosis. Early hospitalization (within 6 hours) and timely initiation of treatment are key factors for success.

Conclusions Late presentation (over 6 hours) is the main cause of intestinal necrosis. Risk factor assessment should be the leading criterion in diagnosis. Early treatment increases the potential for organ-preserving interventions and improves the rehabilitation prognosis.

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