Ozturk Gurkan, Aydinli Bulent, Atamanalp S Selcuk, Yildirgan M Ilhan, Ozoğul Bünyami, Kısaoğlu Abdullah
Department of General Surgery, School of Medicine, Atatürk University, 25240 Erzurum, Turkey.
Wien Med Wochenschr. 2012 Aug;162(15-16):349-53. doi: 10.1007/s10354-012-0120-1. Epub 2012 Aug 28.
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).
急性肠系膜缺血常见于老年患者。本研究旨在表明40岁以下个体也可能出现肠系膜缺血，且其诊断具有挑战性。对26例40岁以下的急性肠系膜缺血患者进行了研究。入院时的主要症状为腹痛。症状持续时间在12小时至5天之间。患者的病史显示，9例既往无疾病。首次评估时，其他17例有易感因素。所有患者均无麻醉剂或药物滥用史。10例患者出现败血症和感染性休克的体征和症状。术前仅6例诊断为急性肠缺血。术前，所有患者均有肠或结肠缺血坏死；1例还伴有肝、胃、十二指肠和胰腺缺血。6例患者有大面积肠坏死。术后总体并发症发生率和总体死亡率分别为61.5%和26.9%。并发症和死亡率被确定与既往肺部疾病、酸中毒、感染性休克的存在、急性肾衰竭、缺血范围和切除范围、二次探查手术、既往心脏事件以及受累肠段类型（结肠受累）有关。
