Open AccessA strategy for improving the prognosis of non‐occlusive mesenteric ischemia ( NOMI ): a single‐center observational study
Author(s) -
Nakamura Fumiko,
Yui Rintaro,
Muratsu Arisa,
Onoe Atsunori,
Nakajima Mari,
Takahashi Hiroki,
Kishimoto Masanobu,
Sakuramoto Kazuhito,
Muroya Takashi,
Kajino Kentaro,
Ikegawa Hitoshi,
Kuwagata Yasuyuki
Publication year - 2019
Publication title -
acute medicine and surgery
Language(s) - English
Resource type - Journals
ISSN - 2052-8817
DOI - 10.1002/ams2.422
Subject(s) - medicine , odds ratio , confidence interval , laparotomy , disseminated intravascular coagulation , univariate analysis , multivariate analysis , single center , bowel resection , surgery
Aim The purpose of this study was to determine the prognostic factors of non‐occlusive mesenteric ischemia ( NOMI ) and to examine treatment strategies that could improve its prognosis. Methods We retrospectively identified 30 patients who underwent emergency laparotomy for NOMI in Kansai Medical University Hospital (Hirakata, Japan) from April 2013 to December 2017. We examined prognostic factors related to discharge outcome and also examined the prognostic impact of open abdominal management and second look operation strategy ( OSS ) by dividing the patients into the non‐ OSS group and the OSS group. Results The primary end‐point was a prognostic factor for outcome at discharge of the 30 patients. The outcome at discharge was compared between the survival group and the death group. Multivariate analysis was undertaken on two items from the univariate analysis that showed a significant difference (computed tomography findings of intestinal pneumatosis and acute disseminated intravascular coagulation [ DIC ] score). As a result, there was a significant difference in the factors of intestinal pneumatosis (odds ratio = 0.054; 95% confidence interval, 0.005–0.607; P = 0.018) and DIC score (odds ratio = 1.892; 95% confidence interval, 1.077–3.323; P = 0.027). The secondary end‐point was the treatment outcome before and after the application of OSS . Operation time was significantly shorter and the amount of bleeding was also significantly less in the OSS group. Conclusion Computed tomography findings of intestinal pneumatosis and the acute disseminated intravascular coagulation score were found to be prognostic factors for survival in patients with NOMI . Aggressive laparotomy to determine the definitive diagnosis is needed and OSS could be useful to improve patient prognosis for survival from NOMI .