Acute mesenteric ischemia in the intensive care unit: A seven-year retrospective study

Background: Acute mesenteric ischemia (AMI) is a rare vascular and digestive emergency associated with high mortality. Its clinical presentation is often nonspecific, which contributes to delayed diagnosis and progression to intestinal necrosis.
Methods: We conducted a retrospective, longitudinal, descriptive and analytical study in the polyvalent intensive care unit A4 of Hassan II University Hospital in Fez over a seven- year period, from January 2013 to December 2019. All adult patients hospitalized for AMI were included when the diagnosis was established preoperatively on clinical, biological and radiological grounds, or intraoperatively. Incomplete records and patients managed only in the resuscitation room were excluded. Statistical analysis was performed using SPSS 20. Quantitative variables were expressed as means and qualitative variables as percentages. Univariate analysis was performed, with statistical significance set at p<0.05.
Results: Sixteen patients were included, representing approximately 0.3% of ICU admissions during the study period. The mean age was 64.8 ± 12.68 years and 62.5% of patients were women. Atrial fibrillation was the most frequent comorbidity (43.75%). The mean delay before consultation was four days. All patients presented with abdominal pain, 62.5% with vomiting and 31.25% with an occlusive syndrome. CT/CT angiography established the preoperative diagnosis in 10 patients. Fifteen patients underwent surgery; intestinal necrosis was found in all operated patients. Invasive mechanical ventilation was required in 81% of patients, vasoactive drugs in 62%, and therapeutic anticoagulation in all patients. Overall mortality was 62.5%. Factors significantly associated with mortality were central venous catheterization, invasive mechanical ventilation and septic shock.
Conclusion: AMI in the ICU remains associated with high mortality. Prognosis depends on early clinical suspicion, rapid CT angiography and multidisciplinary management involving intensive care, digestive surgery and vascular surgery.