Short-term outcome of acute mesenteric vascular occlusion: a comparative study between two centers in Egypt and Ireland

BACKGROUND: Acute mesenteric vascular occlusion (AMVO) is an acute abdomen pathology that has a poor outcome and is time critical. Early diagnosis and treatment are essential to reduce long-term morbidity and prevent mortality however, would the difference between countries in demographics, time of presentation or management strategies and technology have any effect on the outcome of such poor disease? The aim of the current work was to compare management and short-term outcomes of patients with AMVO presented to two tertiary centers in two countries.METHODS: We reported a series of 40 patients collected from 2 university hospitals in 2 continents to compare differences and similarity of management of patients presented with AMVO. Ireland group (group A) were 19 patients, and Egyptian group (Group B) were 21 patients.RESULTS: Group A was significantly older on presentation with a Median of 76 years, range (48-87) whereas group B were younger (Median 62, range 17-81). Both ASA grade and ischemic heart disease (IHD) were significantly higher in group A (P=0.015*, P=0.020* respectively). Management was comparable between the two centers. A total of 34 (85%) had surgical interventions in both groups however, when the offered surgical interventions were compared, superior mesenteric artery (SMA) interventions (Thrombo-embolectomy/ thrombolysis) where significantly higher in group A (P=0.012) whereas major bowel resection was more in group B (P=0.41). The 30-day death rate of all AMVO patients in both hospitals was 45%. Multivariate analysis of variables associated with mortality showed that acute embolic superior mesenteric artery ischemia (AESMI) was the major and the only factor associated with 30-days mortality at with an odds ratio (OD) of 4.44.CONCLUSIONS: AMVO is a surgical catastrophe. There was less vascular and endovascular intervention and more major bowel resection in the Egyptian group. Complications and mortality rates were high in both centers with no statistical difference. AESMI was the only factor associated with 30-day mortality.