Evaluation of damage-control surgery in cases of acute mesenteric ischemia for salvaging small bowel length

Document Type : Original Article

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Department of Colorectal and General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Abstract

Background: In the context of acute mesenteric ischemia (AMI), the extent of bowel resection poses a surgical complexity 
due to the potential exacerbation of mesenteric ischemia postsurgery. Consequently, employing damage-control surgery 
(DCS) alongside a subsequent second-look operation presents an opportunity to effectively address the critical state of the 
patient and evaluate bowel viability after resuscitative measures.
Objectives: Evaluate the role of DCS in salvaging small bowel segments that were doubtful during the primary operation 
after resection of the necrotic bowel. Assess the role of DCS in overall morbidity and mortality.
Patients and Methods: A prospective cohort study conducted at Ain-Shams University Hospitals. A total of 29 
patients were admitted to our department with the diagnosis of AMI and underwent DCS. Twenty-two patients were 
hemodynamically unstable intraoperatively, and seven patients were stable. They were evaluated regarding saving bowel 
length from resection and overall morbidity and mortality.
Results: A total of 29 patients underwent DCS for diffuse mesenteric ischemia with ill-defined margins for gangrenous 
bowel; all patients passed without stump blowout, and further resection of previously query ischemic segments done in 
22 (75.9%) patients, saving bowel length from resection reaching up to 18 cm. Three (10.3%) patients had anastomotic 
leakage that has been managed conservatively; one of them had an enterocutaneous fistula that resolved over 6 weeks.
Conclusion: The DCS strategy (abbreviated laparotomy) offers significant advantages and demonstrates commendable 
outcomes among patients with AMI with diffuse and indistinct margins. This approach notably contributes to preserving 
bowel length and reducing the overall morbidity and mortality rates in affected patients.

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