The Frequency of Gangrenous Infarction of Intestine in Patients Undergoing Intestinal Resection at Tertiary Care Hospital, Rawalpindi
Gangrenous Infarction in Patients with Intestinal Resection
DOI:
https://doi.org/10.54393/pjhs.v5i01.1194Keywords:
Intestinal Gangrene, Intestinal Resection, Ulceration, Infarction, Reactive HyperplasiaAbstract
Gangrenous bowel or dead bowel most often occurs as a result of hernia, adhesions, and mesenteric insufficiency. Intestinal gangrene due to acute mesenteric vascular events requiring surgery is one of the most common surgical emergencies at tertiary care hospitals. Objective: To determine the frequency of gangrenous infarction in patients undergoing intestinal resection at a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted in the Department of Surgery and Pathology, Rawalpindi, Pakistan. A total of 140 resected intestinal specimens were included in this study. Data were entered and analyzed using SPSS v. 23. o. Descriptive statistics were applied and a P-value <0.05 was taken as statistically significant. Results: Out of 140 samples, clinical specimens from 30(21.4%) patients were found to be gangrenous. The frequency of gangrene was slightly higher in females 16 (53.3%) as compared to males 14 (46.7%) with a peak of 19 patients (63.3%) in the age group of 31 to 60 years and mostly affecting the small intestine 21 (70%). Among the total of 110 (78.6%) non-gangrenous specimens; mild inflammatory changes, perforation, ulceration, tumors, mucosal and mural infarction, infection, reactive hyperplasia, and autolytic changes were noted. Conclusions: The frequency of intestinal gangrene is much higher in our population than in most regions of the world, slightly more common in females as compared to males with a peak in the age group of 31 to 60 years and mostly involving the small intestine, indicating negligence towards this important problem.
References
Vallicelli C, Coccolini F, Catena F, Ansaloni L, Montori G, Di Saverio S, et al. Small bowel emergency surgery: literature's review. World Journal of Emergency Surgery. 2011 Dec; 6(1): 1-8. doi: 10.1186/1749-7922-6-1. DOI: https://doi.org/10.1186/1749-7922-6-1
Bhatnagar BN, Sharma CL, Gautam A, Kakar A, Reddy DC. Gangrenous sigmoid volvulus: a clinical study of 76 patients. International Journal of Colorectal Disease. 2004 Mar; 19: 134-42. doi: 10.1007/s00384-003-0534-8. DOI: https://doi.org/10.1007/s00384-003-0534-8
Yusuf NW, Iqbal S, Sarfraz R, Sohail SK, Imran M. Spectrum of pathologies in cases of intestinal obstruction & perforation based on histopathological examination of resected intestine-Report from a third world country. Pakistan Journal of Medical Sciences. 2014 Mar; 30(2): 373. doi: 10.12669/pjms.302.5050. DOI: https://doi.org/10.12669/pjms.302.5050
Aliosmanoglu I, Gul M, Kapan M, Arikanoglu Z, Taskesen F, Basol O, et al. Risk factors effecting mortality in acute mesenteric ischemia and mortality rates: a single center experience. International Surgery. 2013 Feb; 98(1): 76-81. doi: 10.9738/CC112.1. DOI: https://doi.org/10.9738/CC112.1
Huang HH, Chang YC, Yen DH, Kao WF, Chen JD, Wang LM, et al. Clinical factors and outcomes in patients with acute mesenteric ischemia in the emergency department. Journal of the Chinese Medical Association. 2005 Jul; 68(7): 299-306. doi: 10.1016/S1726-4901(09)70165-0. DOI: https://doi.org/10.1016/S1726-4901(09)70165-0
Merle C, Lepouse C, De Garine A, Frayssinet N, Leymarie F, Leon A, et al. Surgery for mesenteric infarction: prognostic factors associated with early death within 72 hours. Journal of Cardiothoracic and Vascular Anesthesia. 2004 Dec; 18(6): 734-41. doi: 10.1053/j.jvca.2004.08.011. DOI: https://doi.org/10.1053/j.jvca.2004.08.011
Dhamnaskar SS, Sawarkar PC, Mandal S, Vijaykumaran P. Predictors of mortality in acute mesenteric vascular ischemia with bowel gangrene. International Surgery Journal. 2016 Dec; 3(4): 1996-2002. doi: 10.18203/2349-2902.isj20163540. DOI: https://doi.org/10.18203/2349-2902.isj20163540
Kougias P, Lau D, El Sayed HF, Zhou W, Huynh TT, Lin PH. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. Journal of Vascular Surgery. 2007 Sep; 46(3): 467-74. doi: 10.1016/j.jvs.2007.04.045. DOI: https://doi.org/10.1016/j.jvs.2007.04.045
Tilsed JV, Casamassima A, Kurihara H, Mariani D, Martínez I, Pereira J, et al. ESTES guidelines: acute mesenteric ischaemia. European Journal of Trauma and Emergency Surgery. 2016 Apr; 42: 253-70. doi: 10.1007/s00068-016-0634-0. DOI: https://doi.org/10.1007/s00068-016-0634-0
Barnett WO, Petro AB, Williamson JW. A current appraisal of problems with gangrenous bowel. Annals of Surgery. 1976 Jun; 183(6): 653. doi: 10.1097/00000658-197606000-00006. DOI: https://doi.org/10.1097/00000658-197606000-00006
Pingleton SK, Hall JB, Schmidt GA. Prevention and early detection of complications of critical care. Principles of Critical Care. Second Edition. Hall JB, Schmidt GA, Wood LDH, eds. New York, McGraw-Hill. 1998.
Raizada A, Apte N, Pham S. Q fever endocarditis presenting with superior mesenteric artery embolism and renal infarction. Texas Heart Institute Journal. 2016 Feb; 43(1): 91-3. doi: 10.14503/THIJ-14-4781. DOI: https://doi.org/10.14503/THIJ-14-4781
Luther B, Mamopoulos A, Lehmann C, Klar E. The ongoing challenge of acute mesenteric ischemia. Visceral Medicine. 2018 Jul; 34(3): 215-21. doi: 10.1159/000490318. DOI: https://doi.org/10.1159/000490318
Liao G, Chen S, Cao H, Wang W, Gao Q. Acute superior mesenteric artery embolism: A vascular emergency cannot be ignored by physicians. Medicine. 2019 Feb; 98(6): e14446. doi: 10.1097/MD.0000000000014446. DOI: https://doi.org/10.1097/MD.0000000000014446
Haglund U. Mesenteric ischemia. In: Holzheimer R, Mannick J, editors. Surgical treatment: evidence-based and problem-oriented. Munich: Zuckschwerdt; 2001.
Chennakeshaviah GR, Cheluvegowda DV, Maggad RS, Vimalambika MG. A Histopathological Study of the Small Intestinal Lesions. National Journal of Laboratory Medicine. 2017 Apr; 6(2): PO14-PO20.
Atamanalp SS, Kisaoglu A, Ozogul B. Factors affecting bowel gangrene development in patients with sigmoid volvulus. Annals of Saudi Medicine. 2013 Mar; 33(2): 144-8. doi: 10.5144/0256-4947.2013.144. DOI: https://doi.org/10.5144/0256-4947.2013.144
Dare AJ, Ng-Kamstra JS, Patra J, Fu SH, Rodriguez PS, Hsiao M, et al. Deaths from acute abdominal conditions and geographical access to surgical care in India: a nationally representative spatial analysis. The Lancet Global Health. 2015 Oct; 3(10): e646-53. doi: 10.1016/S2214-109X(15)00079-0. DOI: https://doi.org/10.1016/S2214-109X(15)00079-0
Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World Journal of Emergency Surgery. 2017 Dec; 12(1): 1-1. doi: 10.1186/s13017-017-0150-5. DOI: https://doi.org/10.1186/s13017-017-0150-5
Mahalingashetti PB, Reddy YJ, Vijay A, Gali SC. A Histomorphological Study of Intestine Resections at a Rural Tertiary Care Centre. Scholars Journal of Applied Medical Sciences. 2016; 4(7): 2636-2642. doi: 10.21276/sjams.2016.4.7.71. DOI: https://doi.org/10.21276/sjams.2016.4.7.71
Vitin AA and Metzner JI. Anesthetic management of acute mesenteric ischemia in elderly patients. Anesthesiology Clinics. 2009 Sep; 27(3): 551-67. doi: 10.1016/j.anclin.2009.07.017. DOI: https://doi.org/10.1016/j.anclin.2009.07.017
Karayiannakis AJ, Bolanaki H, Kouklakis G, Dimakis K, Memet I, Simopoulos C. Ischemic colitis of the left colon in a diabetic patient. Case Reports in Gastroenterology. 2011 Apr; 5(1): 239-45. doi: 10.1159/000327981. DOI: https://doi.org/10.1159/000327981
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