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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

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

Zeitschrift:
BMC Surgery > Ausgabe 1/2015
Autoren:
Samuel A Käser, Tara C Müller, Anna Guggemos, Ulrich Nitsche, Christoph Späth, Christoph A Maurer, Klaus-Peter Janssen, Jörg Kleeff, Helmut Friess, Dirk Wilhelm, Franz G Bader
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

Study conception and design: SAK, AG; Acquisition of data: SAK AG; Analysis and interpretation of data: SAK, TCM, AG, UN, CS, CAM, KPJ, HF, JK, DW, FGB; Drafting of manuscript: SAK, FGB; Critical revision of manuscript: SAK, TCM, AG, UN, CS, CAM, KPJ, HF, JK, DW, FGB. All authors have read and approved the final version of the manuscript.

Abstract

Background

The 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.

Methods

From 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.

Results

Radiologically 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.

Conclusions

Patients 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.
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