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Open Access Research article

Local thrombolytic therapy in acute mesenteric ischemia

Fatih Yanar1*, Orhan Agcaoglu1, Inanc Samil Sarici1, Emre Sivrikoz1, Adem Ucar2, Hakan Yanar1, Murat Aksoy3 and Mehmet Kurtoglu1

Author Affiliations

1 Istanbul Medical Faculty, Department of General Surgery, Istanbul University, Istanbul, Turkey

2 Istanbul Medical Faculty, Department of Radiology, Istanbul University, Istanbul, Turkey

3 Department of General Surgery, Bahcesehir University, Istanbul, Turkey

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World Journal of Emergency Surgery 2013, 8:8  doi:10.1186/1749-7922-8-8

Published: 9 February 2013

Abstract

Background

The aim of the study was to evaluate the local thrombolytic therapy (LTT) in combination with laparoscopy, in management of acute mesenteric ischemia (AMI).

Methods

From January 2000 to January 2010, patients who were admitted to the hospital with AMI due to acute arterial occlusion were analysed retrospectively. Patients presenting with acute abdomen with a suspicion of AMI were evaluated with computerized tomography angiography (CTA). Patients who had findigs of AMI on CTA, were underwent selective mesenteric angiography and LTT eventhough without peritoneal signs. LTT was carried out before or after laparoscopy or laparotomy, and initiated with recombinant plasminogen activator.

Results

LTT was performed in 13 (17.1%), out of 76 patients. From the remaining patients, 56 underwent necrotic bowel resection and 7 underwent tromboembolectomy. The median age was 62 years (45–87). The median duration of symptoms was 24 h. Four (30.7%) patients presented within 24 h onset of symptoms, whilst 9 (69.3%) patients presented after 24 h onset of symptoms. There were 5 (39.5%) patients, who presented with abdominal pain without peritoneal signs on physical examination and 8 (61.5%) patients, who had peritoneal signs. The mortality rate was 20% (1/5) in the first group who presented without peritoneal signs, whilst it was 62.5% (5/8) in the remaining.

Conclusion

Early intervention in AMI is the key to better results. CTA combined with early laparoscopy and LTT may have beneficial effects at this setting.

Keywords:
Acute mesenteric ischemia; Thrombolysis; Laparoscopy; Second-look; CT-Angiography