Clinical symptoms of visceral ischemic syndrome and indications for urgent laparotomy

Indira Mehmedagić and Mirza Mešić

Acute and chronic visceral syndrome can be dramatic or slow in its onset. Early detection of symptoms and prompt diagnosis can aid the surgeon in his decision to perform emergency laparotomy. Surgical therapy includes a resection of the dysfunctional part of the intestine and the use of anticoagulant therapy. Occlusive ischemic syndrome manifests it self as an intestinal edema, loss of mucosa and a disorder of absorption in the gut. Prolonged ischemia can lead to spreading of the disease throughout the entire thickness of the intestinal wall, causing gangrene. A history of previous operations, sudden abdominal pain, without abdominal guarding, meteorism, vomiting, arterial fibrillation and laboratory parameters can define the exact time to perform a laparotomy.

The aim is to establish recognizable symptoms in the history of the illness and diagnostics. Therapeutic administration of low-molecular-weight heparin and resection of the bowel offer a better chance for patient survival.

Patients and methods: The five-year study, from 2011 to 2016, included 47 operated patients, 25 men and 22 women. The following diagnostic test were performed: electrocardiography (ECG) to prove arterial fibrillation, native radiographic recording of the abdomen (RTG) to prove intestinal dilatation and aeroliquid levels, and laboratory parameters of urea and creatinine. Symptoms of pain, vomiting and hematochezia, were included in the study. All parameters were established on the day of admission to the hospital.

Conclusion: Emergency operation in the first 24 hours of the onset provides a better survival chance. High levels of urea, creatinine, atrial fibrillation and an X-ray of the abdomen are good indicators of urgency for emergency laparotomy. Colostomy and ileostomy have proven to be procedures which give a higher chance for the patient's survival. These bowel resection methods provide relief which reduces the intestinal edema. Surgical complications of anastomoses in the intestines in the first 10 days of the post-operative period ended by performing the stoma and patient survival chances were higher with high doses of low-molecular-weight heparin.

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Indira Mehmedagić and Mirza Mešić, 2017, Clinical symptoms of visceral ischemic syndrome and indications for urgent laparotomy, International Journal of Current Science and Technology, Vol.5, Issue, 5, pp.419-422